CIHM 
Microfiche 
Series 
(l\Aonograplis) 


ICIVIH 

Collection  de 
microfiches 
(monographies) 


I  Ell 

Canadian  Instituta  for  Hiatorical  Microraproductiona  /  Inatitut  Canadian  da  microraproductiona  hiatoriquaa 


1996 


Technical  and  Bibliographic  Notes  /  Notes  technique  et  bibliographiques 


The  Institute  has  attempted  to  obtain  the  best  original 
copy  available  for  filming.  Features  of  this  copy  which 
may  be  bibliographically  unique,  which  may  alter  any  of 
the  images  in  the  reproduction,  or  which  may 
significantly  change  the  usual  method  of  filming  are 
checl<ed  below. 

rnf     Coloured  covers  / 
'-^      Couverture  de  couleur 


n 

D 

n 
n 

D 

n 
n 
n 

D 


Covers  damaged  / 
Couverture  endommag^ 

Covers  restored  and/or  laminated  / 
CouveituiB  restaur^  et/ou  pellicuiee 

Cover  title  missing  /  Le  tKre  de  couverture  manque 

Coloured  maps  /  Cartes  geographiques  en  couleur 

Coloured  ink  (i.e.  other  than  blue  or  black)  / 
Encre  de  couleur  (i.e.  autre  que  bleue  ou  noire) 

Coloured  plates  and/or  illustratkxis  / 
Plancties  et/ou  illustrations  en  couleur 

Bound  with  other  material  / 
ReiiS  avec  d'autres  documents 

Only  edition  available  / 
Seule  edition  disponible 

Tight  binding  may  cause  shadows  or  distortion 
along  interior  margin  /  La  reliure  serr6e  peut 
causer  de  I'ombre  ou  de  la  distorsion  le  long  de 
la  marge  Int^rieure. 

Blank  leaves  added  during  restorations  may  appear 
within  the  text.  Whenever  possible,  these  have 
been  omitted  from  fUming  /  II  se  peut  que  certaines 
pages  blanches  ajouttes  lors  d'une  restauration 
apparaissent  dans  le  texte,  mais,  kxsque  cela  toit 
possible,  ces  pages  n'ont  pas  M6  filmtes. 


L'Institut  a  mictofilme  le  meilleur  examplaire  qu'il  lui  a 
6t6  possible  de  se  procurer.  Les  details  de  cet  exem- 
plaire  qui  sort  peut-6tre  uniques  du  point  de  vue  bibli- 
ographique,  qui  peuvent  modifier  une  image  reproduite, 
ou  qui  peuvent  exiger  une  modifications  dans  la  m6th- 
ode  normale  de  filmage  sont  indiques  cl-dessous. 

I     I      Coloured  pages  /  Pages  de  couleur 

r~|      Pages  damaged/ Pages  endommagies 

I     I      Pages  restored  and/or  laminated  / 
— '      Pages  restaurtes  et/ou  pelllcultes 

pi      Pages  discoloured,  stained  or  foxed  / 
Pages  decolorAes,  tachet^es  ou  piqutes 

ry\     Pages  detached/ Pages  d^tachSes 

r7|      Showthrough  /  Transparence 

I     I      Quality  of  print  varies/ 

' — '      QualNe  inigale  de  I'imptesston 

I     I      Includes  supplementary  material  / 

Comprend  du  materiel  supplementaiie 

I  I  Pages  wholly  or  partially  obscured  by  errata 
slips,  tissues,  etc.,  have  been  refilmed  to 
ensure  the  best  possible  image  /  Les  pages 
totalement  ou  partiellement  obscurcies  par  un 
feuillet  d'errata,  une  pelure,  etc.,  ont  6t6  filmies 
k  nouveau  de  fa;on  a  obtenir  la  meilleure 
image  possible. 

I  I  Opposing  pages  with  varying  colouration  or 
— '  discolourations  are  filmed  twk:e  to  ensure  the 
best  possible  Image  /  Les  pages  s'opposant 
ayant  des  colorations  variables  ou  des  decol- 
orations sont  film6es  deux  fois  afin  d'obtenir  la 
meilleur  image  possible. 


D 


Addnional  comments  / 
Convnentaires  suppl^mentaires: 


Thit  ittm  if  fihnad  tt  tl<t  nduetion  ratio  dMCktd  below/ 

Ce  document  est  filmi  lu  taux  d«  ridunion  indiqut  ci<l«taiis. 

lOX  14X  IgX 


20X 


22X 


»x 


y 


Th«  copy  fllmad  hara  hM  baan  raproduead  thanka 
to  tha  ganarmitv  of: 

D.B.  WiMon  Library 
Univinity  of  Wftttm  Ontario 


L'axamplaira  film*  fut  rapredult  griea  t  la 
gtntroait*  da: 

D.B.  Wtldon  Library 
Univtrtity  of  Wnttrn  Ontario 


Tha  imagaa  appaaring  hara  ara  tha  bait  quality 
poMlbIa  conaidaring  tha  condition  and  laglbility 
of  tha  original  copy  and  In  kaaping  with  tha 
filming  contract  apaelflcatlona. 


Laa  Imagai  luivantat  ont  Ati  raproduita*  avac  la 
plua  grand  «oin,  eompta  tanu  da  la  condition  at 
da  la  nattata  da  raxamptaira  filma,  at  an 
eonf  ormM  avac  laa  conditions  du  contrat  da 
fllmaga. 


Original  coplaa  in  printad  papor  covara  ara  tdmad 
baginning  with  tha  front  covor  and  anding  on 
tha  laat  paga  with  a  printad  or  illuatratad  Impraa- 
alon.  or  tha  back  eovar  whan  approprlata.  All 
othar  original  coplaa  ara  fllmad  baginning  on  tha 
firat  paga  with  a  printad  or  Illuatratad  Impraa- 
alon.  and  andIng  on  tha  laat  paga  with  a  printad 
or  Illuatratad  Improaaion. 


Las  axamplalras  originauii  dont  la  couvartura  an 
papiar  ast  Imprlmia  sont  fllmts  an  commandant 
par  la  pramiar  plat  at  an  tarminant  soit  par  la 
darnMra  paga  qui  comporta  una  smprsints 
d'imprasslon  ou  d'lllustratlon,  soit  par  la  sacond 
plat,  aalon  la  eas.  Tous  las  auiras  sxampiairas 
orlglnaux  sont  fllmta  an  eommanfant  par  la 
pramMra  paga  qui  comporta  una  amprainta 
dimpraasion  ou  d'HIustratlon  at  an  tarminant  par 
la  darhitrs  paga  qui  comporta  una  talia 
amprainta. 


Tha  laat  racordad  frama  on  aaeh  mieroflcha 
shall  conuin  tha  symbol  —^  (moaning  "CON- 
TINUED"), or  tha  symbol  Y  (moaning  "END"), 
whichavar  appllaa. 


Un  daa  aymbolaa  sulvants  spparattra  sur  la 
darnMra  Imsga  da  ehaqua  mieroflcha.  salon  la 
cas:  la  symbols  —^  signifia  "A  SUIVRE".  la 
symbols  V  signifia  "FIN". 


Mapa.  platas.  charts,  ate.,  may  ba  fllmad  at 
diffarant  raduction  ratios.  Thosa  too  larga  to  ba 
antlraly  Included  In  ona  axpoaura  ara  fllmad 
baginning  In  tha  uppar  laft  hand  eornar.  laft  to 
right  and  top  to  bottom,  aa  many  framas  as 
rsqulrad.  Tha  following  diagrama  illustrata  tha 
mathod: 


Laa  cartaa.  planchos.  tablaaux.  ate.  pauvant  Mra 
filmte  i  das  ttux  da  rMuctlon  dlfftrants. 
Lorsqua  la  document  ast  trap  grand  pour  ttra 
raprodult  an  un  saul  elicha.  11  est  flimt  t  partir 
da  Tangle  aupirlaur  gaucha,  da  gauche  t  droita. 
at  da  haut  an  baa.  an  prenant  la  nombre 
d'imagaa  nicassaire.  Las  disgrammes  suivanu 
lllustrent  la  mMhode. 


1  2  3 


1 

2 

3 

4 

5 

6 

ITA!,    i; 


(    I  M  >    (      i 


I    A    '    ( 


I  ROO!  i 


A.tJ 


THE   UNIVEBSITT  OP  CHICAGO 


The  Decennial  Publications 


A  DESCRIPTION  OF  THE  BRAINS  ANl)  SPINAL  CORDS  OF 
TWO  JiROTHERS  DEAD  OF  HEREDITARY  ATAXIA 

CASES  -^"'J^^ND  XX  OF  THE  SEBIE3  IN  THE  FAMILY  DESCRIBED  BV  DB 

SA.XOER  BROttN.      WITH  A  CLIXICAI,   INTRODUCTION 

BY  DR.  SANGER  BROWN 


LEWELLYS  F.  BARKER 

AND  HKAD  O*  TRH  DKPABTMKNT  np  A 


PRINTED  FROM   VOLUIIE  X 


CHICAGO 

THE  UNIVEKSITY  OP  CHICAGO  PRESS 

1903 


Copyright  tsos 

BT  THE  UNITXR8ITT  OF  CHICAQO 


PWNTED  SKPTEHBER   1.  IOCS 


rsPOT 


A  I)ES(  RinrON  OF  THK  BRAINS  AND  SPINAL  fORDS  OK 
TWO  ItROTHERS  DKAI)  OF  HEKEDI'I  AHY  ATAXIA 

CASEH  \V\'i   AND  .XX  OF  THE  SERrKS  IX  THR   FAMILY  DFSCHinEI)  IIV  nil 

SANOEK  SHOWS.      WITH  A  CLINICAL  INTlioDltTION 

DY  DR.  .SANGER  fillUWN 

LiiriLLii   F.  Ba«K£» 

of  Pnfl,ol,w  .n  .I„hn»  H„,,kin.  t'„iv,.r»ilj,  .1,,,  kindly  turno.!  it  over  to  m:  I  ,.i,l, 
to  o,pr„„,  my  thnnk,  to  1k„1,  lhe«.  r..,,,!™,.  ,  for  th.  op,„ri„..i,y  they  lmv„  Riven  „„ 
of  »lu,l,-,nK  Iho  imlh..loKi,„l  -hang™  in  .  di«.«„.  ho  rnrely  nut  n-itl, 

.^'•"/''"'■"■''"'"'■'''"'"""'omical  finding,  will  l«,,r«,.,l...il,y  a  Clinical  Intro- 
duction by  Dr.  Saugir  Brown. 

CLINICAL  INTBODtCTION  IIV  DR.  SANtiFK  BROWN 

A«  an  intro,ln<.>.on  to  Dr.   Lewellya  BarkerV  Anatomieal  Report,  and  f„r  the 

pnrpore  of  (acd.tat.ng  correct  deductiona  therefrom,  ,»  weK  «a  for  the  convenience  ,  f 

tho».   ,„tere,ted  who  either  have  not  read  or  do  not  now  distinctly  rem™,l»rnrv  .Mni- 

cal  reiH.rt  of  the  aeriea  flrat  publiahed  in  1M12  in  y?„„„  and  in  the  .Vor/A   .l™cr,„,» 

Pr„vl,U<nUT,  I  shall  undertake  to  anpply  ,on,e  data  intended  '.o  ^ive  a  Reneral  ..i f 

he  charactenatic  clinical  fe.tnrea,  together  with  a  reproduction  of  n,y  original  t^.-ne,. 
logical  chart  (»ee  next  ,«ge)  .bowing  the  hereditary  relation  of  the  di«,«:-,  «,d  the 
ago  at  wh.,h  It  first  made  it.  appearance  in  the  indi-iduals  nfTccted.  Kinally  I  .hill 
furnish  a  more  particular  hUtorv  of  the  case,  supplying  the  u,alerial  for  Dr.  Barker,, 

Pr"m  a  careful  survey  of  all  the  case,  compri«.d  in  the  series,  I  presented  in  mv 
ongina.  paper  a  general  aummory,  which  I  here  quote  : 

"Taking  these  cases  alone  for  a  text,  and  assuming  them  to  l,e  cases  of  hereditary 
ataxia,  the  following  diagnostic  criteria  might  be  fairly  deduced : 

"  Hereditary  ata.xy  is  a  disease  which  may  be  trace,  through  several-at  least 
four-generations,  increasiijg  jn  ^^|;,t  pnd  intensity  as  it  descends,  tending  to  occur 
earlicjmjife  and  to  advance  more  rapidly  It  usually  atta.-ks  several  members  of  Iho 
same  family  It  «,.  .rs  most  frequently  between  the  ages  of  sixteen'IT'thirtv.fiv. 
but  It  may  b..gin  as  early  as  eleven  and  as  late  as  forty.five.  It  shows  nlTa-ked 
preference  -or  sex,  but  it  descends  through  fen.ales  four.times  as  freqiientlT  as  through 
males.     AtavismjaaJf^eccurs.     The  inauence  of  an  lidting"  cause  can  rarely  be 

S19 


4      Di:« 


'"    H.»l!.    AM,  S|.,l,AI.£oiD   ■>■    HeilllI„TV„     \TA.1* 


/ 


(InnintiHtrnltil.  tint  in  wtiiif  lnHtni.......  ,.  /„m  ■    ■ 

•■  "    "•<"•  '""  '"  »  '''»  "M'mtln  or  jfnni  piIitiiIh  i„   ||ir 


II .ilizss  I 


mm 


'V  ilEREDITAKy  ATVXV 

move.enU„f  ,„o  head,  .„d  „«e„  „,  „.  .™„  .cco.pan.liihlS^r 

360 


LEwiiiiis  K.  Baoii 


TOnl.     Tli.«  lrn.K,,l„,  mov..»„.„l.  .»-..„r  l„  IhH  l,n,„l..  I,«.,  ,„  |,.,„,,  ,,,„„,,„,  „  ,. 

.■ffort.     M„v,.m,.„l  ,...„».. „«  .,,„,,     Th,.  ,,„l«..r„l..  n.Sj  l/  ,,„.„.„?,"■"*„ 

•Uiraii.wl  iiiw,  „r  niiiy  k.  iiurnmr  ""  r.ii«.,i  t„   1 1.  In 

u-7«"'ffi~^^^!^::;'Si-^  -  - 

u..  ,..„u„e™.,n,.„... , '„„.,:° ,  ^t'S^;:^:;:; ^,;:- 

«^..«.-  .i...Vi(.rTn,nmijr.7sf.nr.T-R.-;;„  av^^j^^j:,:!  ;"r;i'i 

wm   llu»,l>  .,„■,..,   Hum., ,l„.->K.rv„„,r„,,h,-i    wh...,  tl.U  la.l.T  i,  ,.,.,n,,k.„.    «,  ,„„    -^ 

,';,".!;:""""'■"" '■■"--."—>■  !»•  -u„,i..,„  „..,.„„„  „„.,  ,...„„:,  „,;j„;2 

thrlr  j:       „g  into  ,),„  l,r,.,„,  ,„,,  „„„„i^  ,„||„wi„g  i.  i„  „„  „„,  :,i,„,'„|, 

:'"'""'°"""i'  '>•  ^I'l'ilmUa  arajligli.to  fc"t  J^,itiv,.|y,   ,(r,v|,..l,  ll,i»„nii.toni 
•P  »■«„,«  o„  ,  in  „,.,™  e».e,  w......  «,„„..n„,„,  p,t;.^n  tlf,.  l,.K«c,..,  „,    1    ;     Z 

va^ojlUte  u,  1  „j,l,,c  ,ju       a,,,  bm  tluT,.  ..  ,  n..ried  tendency  to  ^..-Ulion  •  .l,e« 

"Tl,cr..i8„ev,.r,H,rnl,tic  club-foot,  nor  any  other  deformity  ,.x.e, „  rnrdv 

permanent  »,».,ie  ,,,„,r..,iona  of  the  !.«,  in  advanced  ca...     In  n„nc  of'     I.       s^ 
have  the  paMenl.  cvr  auffercKi  from  rbcnnmli.m,  »o  far  „«  I  can  learn 

I  wi»l,  to  re|»at  that  tl.e  above  aummary  of  the  svmpt..n,ntnl„sy  of  hereditary 
.taxy  .a  on  y  .amended  to  apply  to  this  ,«rticular  ^-riea"  ,.f'  caae.  ;  '  ,,  J  IJ^fZl 
p.^a.....ed.t,nth..way«,  that  it  might   k,  the  n.ore  eaaily  compar^.d   with  oXr 

Dr    Bart!"  ""^  ?'"'-°  f"""  "^  "*''"''  ^^'  ""  "^^^"^  "o"'  "'  ""^'  "'■««'  "P""  '^W.^h 
Dr.  Barker  a  anatomical  re,x,rti,  founded,  indicating  any  omiaaiona  or  addHiona  by 

il«lf,   the  note,  may  appear  aomewhat  unneceaaarily   full  an,l  eirc^umatanlial.     In 


6      Descsiption  of  B»ais  aku  Simnai  Oobd  in  Hebeditabv  Ataxia 


extenuation  I  beg  to  Btn<e  thnt  when  the  observationa  were  made  I  felt  I  was,  ,>erhap8, 
exploring  a  new  territory  and  naturally  wished  to  establish  the  elinical  landmarks  as 
firmly  as  poasible.  To  this  end,  with  the  kind  co-operation  of  the  family  physician, 
Dr.  R.  L.  .lames,  I  presented  (happily)  the  two  identical  cases  now  under  discussion 
in  person  before  the  Neuro'ogical  Section  of  the  American  Medical  Asstx-iation  at  the 
1SS12  meeting,  in  Di'troit,  where  they  were  seen  by  some  of  the  test,  known  represen- 
tative  neurologists  of  this  country  and  by  Dr.  James  Taylor,  of  London. 
clinical  notes  op  case  XVIII.  made  in  may.  1891 

A  business  man,  thirty,  single,  of  lemperato  habits,  g,»d  family  history,  except  thai  his 
mother  became  ataxic  at  nlKrat  thirtythiee,  the  disease  preijressing  steadily  until  »he  die<i  of 
tuherciirdmrrlraaal  torty-.ight.  The  patient  «a,  active  and  vi^Mrous  in  every  way  until 
attacked  by  h.s  pr-sent  di««a»e,  being  rather  among  the  foremost  in  all  athletic  sports  and 
school  work,  Hi.s  attention  was  first  attracted  to  this  disease  while  he  was  working  with  a  sur- 
veying parly  in  Teias,  and  then  it  was  noticed  by  others  before  he  himself  noticed  it.  At  that 
time  ho  »ii,  twenty  yean.  old.  and  the  ataxy  was  manifested  by  a  staggering  gail,  which  was  so 
marknl  that  h.s  chief  thought  him  biloxicated;  but  now  he  recollects  that  at  Irast  two  years 
before  this  or  when  he  was  eighteen  ye.irs  old,  the  draughtsmen  in  the  office  where  he  worked 
complauu-d  that  he  rendered  their  desks  or  drawing  l«xird8  «>  unsteady  when  he  I.  .  led  against 
then,  that  they  could  not  well  go  on  with  their  work;  and  ho  further  distinctly  reimmlHirs  that 
on  a  certain  occasion  at  about  this  time,  when  in  company  with  other  young  men  in  the  country 
he  was  quite  unable  to  Mid  the  large  letters  of  an  advertisement  at  a  considerable  distance 
though  each  of  hla  companiona  could  read  them  with  comparative  ease.  He  feels  couadenl  that 
this  comparative  visual  defect  had  not  always  existed. 

I  should  say  here  that  this  patient  has  a  good  English  education,  and  that  his  intellectual 
capacity  is  above  the  average,  so  that,  notwithstanding  his  affliction,  he  would  at  the  present 
time  be  justly  regarded  as  a  well-informed  man.  He  feels  quite  certain,  loo-and  in  this  he  is 
corrol».rated  by  his  older  relatives  who  have  had  an  opportunity  of  observing  him  closely- 
thai  at  the  ago  of  fourteen,  when  his  voice  underwent  the  change  incident  to  puberty,  there 
appe,ared  a  gradually  increasing  defect  in  utterance;  his  speech  was  slower  and  his  syllables 
less  deflnite  and  distinct  than  formerly.  The  ataxy  has  always  been  much  more  pronounced  if 
he  was  fatigued,  and  ho  now  remembers  that  at  the  ago  of  eighteen  he  could  not  walk  in  a 
straight  line  when  very  tired. 

There  has  been  some  progressive  loss  of  power  in  the  legs  from  the  flrsl.  but  this  has  been 
insigmficaul  throughout  in  comparison  with  the  ataxy.  As  already  stated,  the  ataxy  was  Ural 
noticed  in  the  legs  and  has  progressed  more  rapidly  in  them  than  in  other  situations.  But  it 
has  been  distinct  in  the  arms  from  a  very  early  period. 

At  no  time  has  there  been  any  pain  or  any  other  disturbance  of  sensation;  neither  has 
there  been  any  muscular  wasting,  cramp,  or  trophic  manifestations.  The  sphincters  have  not 
been  affi^ctKl,  and  the  patient  thinks  sexual  power  has  not  Ix-u  more  impaired  than  can  he 
attnbutsd  to  the  general  decline  in  bodily  weight  and  strength,  which  has  gradually  supervened 
in  the  past  six  yeara,  the  weight  having  fallen  from  136  to  112  pounds  in  that  period. 

I  should  have  stated  that  a  tendency  to  choke  [strangle]  while  eating  has  all  along  been  a 
troublesome  symptom. 

11  ht      '  '"""™'  y<*"  P""'  ™'0"  •»•  progressively  failed,  so  that  he  could  Ik-sI  read  in  a  dim 


Lewellts  F.  Babxeb 


THE  PRESENT  CONDITION 

Patient  is  considerabljr  emaciated,  though  he  eats  fairly  and  sleepii  we]].  He  a  of  medium 
size  and  well  formiKi.  The  .ensibility  is  normal ;  the  iiuee-jerk  is  gieatly  eiaggerated  and  equal 
on  both  sidesi  there  is  a  .Ughl  anUo-clonusi  the  skin  refleses  appear  in  the  main  noniial,  but 
the  cremasleno  and  abdominal  are  not  strongly  pronounced.  There  is  marked  ataxia  in  noarlv 
al]  voluntary  movementsi  so  that  the  patient  can  walk  only  when  supportinl  by  an  alteadani, 
and  can  stand  only  when  loaning  against  some  solid  support.  Closure  o(  the  eyes  docs  not 
malenally  increase  his  difficulty.  The  gait  is  such  as  would  usually  l»  dccrilied  as  C'rebcllar; 
the  patient  leans  rather  backward  against  his  attendant  and  sways  from  side  to  side  and  al]  the 
time  h.l3  an  uncomfortable  sense  of  insecurity,  as  if  his  head  must  fall  backward  to  the  ground. 
He  elpenencea  a  distinct  loss  of  power  la  the  legs,  which  he  thinks  is  even  greater  than  could 
be  accounted  for  by  his  general  decline  in  bodily  vigor,  but  the  muscles  a™  firm  and  w.ll 
developed.  All  the  voluntary  muscular  movements  aro  slowly  performed,  and  of  this  the  patient 
is  quite  conscious.  He  cannot  reach  out  his  hand  suddenly  to  seize  any  given  object.  The 
hand  moves  slowly  and  deviates  sc^vera]  inches  in  various  directions  from  the  direct  Une  that 
would  normally  be  taken  in  such  an  effort.  This  tardiness  of  movement  is  readily  noticed  when 
the  patient  nuses  his  eyes;  on  being  addressed,  or  in  winking,  the  eyelids  will  rise  so  slowly  as 
to  bo  suggestive  of  tempomry  ptosis,  but  in  the  end  they  are  raised  too  high,  so  that  the  scle- 
rotic IS  often  so  much  eiposed  as  to  display  au  expression  usually  associated  with  some  intense 
emotion,  when  in  fact  the  patient  is  suffering  from  no  emotional  disturbance  whatever.  Though 
atasy  in  the  muscles  that  move  the  tongue  would  lie  difficult  of  conclusive  demonstration, 
because  the  normal  movements  could  hardly  be  definitely  described  (and  the  same  might  be 
said  of  the  muscles  that  move  the  lips),  yet  a  careful  observer  would  see  at  a  glance  that  the 
movement  of  both  tougue  and  lips  (especially  the  former  in  this  case,  because  a  full  beard  is 
worn)  were  far  wider  in  range  than  usual.  There  is  no  difficulty  in  swallowing,  eicepting  the 
tendency  to  choke  already  noticed,  which  might  be  explaiuid  by  ataxy  and  tardiness  of  the 
muscOes  concerned,  because  no  extraordinary  effort  has  to  be  made,  and  there  is  no  tendency  for 
uqmds  to  pass  out  through  the  nose. 

There  is  a  marked  inco-oidination  of  the  various  muscles  of  facial  expression,  which  is 
easily  observed  when  the  changes  are  going  on  incident  to  the  discussion  of  an  absorbing 
topic,  the  action  being  more  marked  now  in  this  group  of  muscles  aud  now  in  that,  so  that 
people  casually  meetmg  the  patient  frequently  get  the  impression  that  there  is  some  mental 
defect. 

There  is  no  spontaneous  movement  during  sleep  or  waking  repose,  but  a  comparatively 
allphl  voluntary  movement  gives  rise  to  very  extensive  and  peculiar  movements  in  muscles  far 
removed  from  those  required  for  the  execution  of  the  act.  For  instanc-,  when  the  patient  puts 
out  his  hand  to  take  a  book  from  a  table  beside  which  he  may  be  sitting,  the  whole  upper  part 
of  the  body  goes  through  a  series  of  irregular  movements  highly  suggestive  of  chorea.  This  is 
particularly  the  case  with  the  head,  which  is  somewhat  inclined  forward,  moved  from  side  to 
side,  and  the  chin  is  protruded;  and  there  is  often  an  associated  movement  of  the  other  hand. 
In  none  of  these  movements  is  there  ever  anything  approaching  a  jerk. 

oculist's  bepobt.' 
Patient  states  that  tor  ten  years  past  he  has  suffered  from  some  gradual  impairment  of 
vision  and  has  had  double  vision  al  limes,  of  not  more  than  a  few  days'  duration,  but  not  for 

...LT'il.'l.'"!''^  i""."  "'"""J""  »«">tl>o'o»«U»      .»d  XX)  w.™  mtat.1,  ...mlnrf  br  Dr.  r.»,  Wo«l.  P„> 

mology  In  th«  Woman-*  MBdiosl  Oollwt...  whoso  reports  I       School  in  thu cltr.  •«  -"uicw 

herewith  sppand.  And  two  of  tholeiie  ndvuuHsi  eues  (XIX 


8     Desobiptiok  of  Bbaik  akd  Spinal  Cobd  is  Hebeditaby  Ataiia 


urneml  yrars  past.  EsaminatioD  ahows  marked  plonis  when  Iho  paliont  ia  at  rest,  but  by  an 
i/ITort  he  am  niiso  the  lids,  ahiming  scleiolio  nlxive  the  cornea  when  the  ujea  are  dintteil  "in  a 
honzontnl  piano.  There  i»  pcrfret  co-ordination  of  the  ocukr  nins<aes  except  to  ejtremo  ri^ht, 
where  there  i»  .lisht  lagging  of  the  external  [lateral]  rcctua  — not  enough,  however,  for  the 
production  of  diplopia;  the  lida  and  conjunctiTe  are  normal. 

The  pupils  re«pond  to  light  but  i-ery  slowly  i  and  the  sinie  is  true  of  accommodation. 
Dilatation  also  occurs  slowly  on  stimulation  of  the  akin  of  Iho  mck. 

Vision  is  2(J/20O  in  cither  eye.  Snelkn  No.  6  mn  be  n'ad,  though  with  difflcultv,  at  ci-ht 
inches  in  an  oidinnry  light]  much  more  easily  in  a  dim  light. 

The  ophthalmoscope  shows  a  decided  blanching  of  the  optic  discs  and  lessening  of  the 
caliber  of  the  arteries,  with  slight  but  distinct  atrophic  chungi^a  in  tUo  retina. 

There  nti-only  slight  iwripheral  limitations  of  the  field,  and  almost  complete  colorblind- 
ness,  red  only  being  distinguished  with  any  degrc.}  of  certainty. 

[Articulation  was  very  much  affected,  and  in  riew  of  this  fact  I  am  greatly  suiprisiHl  that 
1  did  not  call  attention  to  it  more  explicitly  in  my  original  publication.  By  exercising  much 
care  and  delitonition  the  patient  was  easily  understood,  but  even  then  tlio  labials  were  often 
uidiatinct!  with  less  attention  the  articulation  became  somewhat  confluent,  with  considerable 
elision  in  polysyllables.  Forced  utterance  was  conspicuous,  owing,  obvionslv,  to  incoordina- 
tion between  the  muscles  concerned  in  niipiration,  articulation,  and  phonntion  respectively.] 

All  the  almve-descrilied  symptoms  advanced  now  more  rapidly,  now  more  slowly,  up  to 
the  time  of  death,  which  oc-cumxl  from  simple  exhaustion,  emaciation  having  liecomo  extreme, 
and  no  mtercurrent  disease  having  been  discovered  either  by  ante-  or  post  mortem  examination. 
For  several  days  prior  to  death,  the  patient  was  unable  to  utter  a  sound  or  move  a  limb ;  the 
only  evidence'  ho  gave  that  he  heard  what  was  said  to  him  having  been  alTordi'd  by  a  slight 
movement  of  the  brows. 

For  the  last  three  years  he  had  been  unable  to  see  well  enough  to  read,  but  up  to  the  end 
he  could  distinguish  outlines  of  large  figures  under  favoring  conditions  of  light.  The  articula- 
tion had  gradually  failed,  so  that  fora  number  of  months  it  had  Ijeen  little  more  than  a  succes- 
sion of  grunts,  intelligible  only  to  his  nurses,  and  vocal  efforts  almost  invariably  provoked 
paroxysms  of  coughing  with  distressing  signs  of  stmngulatioii.  For  fully  a  year  before  the  end, 
and  while  he  still  had  sufficient  strength,  he  was  unable  to  use  table  utensils  in  eating,  and 
though  he  could  support  his  weight  on  his  legs,  he  could  make  no  progress  in  walking  on 
account  of  the  extreme  ataxia,  even  when  assisted,  and  for  more  than  a  year  had  ceased  making 
the  attempt.  ^ 

CUSECAl.  NOTES  OF  CASE  XI,'  BBOTHEB  OF  CASE  XVIII.  MADE  IS  JUNE,  1891 
Business  man,  twenty-four,  single,  well  developed,  cheerful  disposition,  and  correct  habits. 
General  health  always  good.  Did  well  in  his  studies  at  school  and  excelled  in  athletic  sports. 
The  ataxia  appeared  without  exciting  cause  ol  the  age  of  eighteen.  The  unsteadiB^sot  goil 
and  some  uncertainty  in  use  of  the  hands  and  difficiilty  of  articulation  came  on  togSSTand 
not  until  two  years  later  was  any  visual  defect  realiiS  "Be  has  carried  a  cane  for  the  last  few 
months,  but  can  walk  fairly  well  without  one,  though  deviating  considerably  from  a  straight 
hue.  He  thinks  his  strength  is  in  no  way  impaired,  for  onlyil  few  weeks  ago  he  rode  a  suc- 
cessful tandem  race  with  a  brother  who  is  not  affected. 

^iQa^macb  aa  death  iN^cnrreil  in  this  casa  in  a  com- 
paratively parly  sta^i.cf  the  iiisauso.bothfmm  my  notes  nud 
from  memory  I  have  nipanded  and  elaborate,!  somewhat 
the  reeord  as  ftrst  imblished.  At  that  time  it  only  appeared 


necaasarr  to  Identify  the  ease  so  as 

poratiim  into  the  series.    Now  it  isa,|iie-tioa  o 

ing  the  anatomical  fiadio«a  with  the  aymptoms. 


LsnELLvs  F.  Babkeb 


fl 


IXAHINAnON 

J}"'  '"'ee-yrlia  are  iiinrkedly  eiaggemti'd  and  all  other  refciM  active.  There  is  well- 
marked  ataiM  III  all  loilre«treinllle«r  All  ii«ual  movement»,-)imrevtTrHmlK.  p..rfoniied.  though 
with  evidently  increased  aeliheralion  and  nitention.  When  in  npoae  the  fiieial  niuaelea  are 
conwderablLrelaxed.  Kivhig  the  patient  a  heavy  and  «tolid  eipreasion.  which  i»  often  quite  at 
variance  with  the  prevailing  .tate  of  mind.  But  during  conversation  the  eipreauou  is  siniikr 
to  that  already  noted  in  the  precediui;  case. 

occlist's  report 
1  . '''''™  ■'  markaLstatitptosis,  greater  in  the  left  eye,  with  inoo-ordinate  overaction  of  the 
levator.  All  movement»  of  the  ocular  muscles  and  all  pupillary  reflejea  are  sluggish.  All  are 
p»»enl,  however,  ami  iu  no  event  can  nystagmus  !»■  pnxluced.  ViaSTiJaj/SO  in  each  eye,  aud 
Snellen  ^o.  3  IS  read  well  enough  at  ten  iucli™.  Patient  reads  much  hotter  in  a  dim  light. 
Ihe  average  expert  would  pronounce  the  fundus  normal,  without  knoWWg  anytlung  o(  iho  con- 
dition  of  "siou.  The  color-sense  is  not  much  affected,  and  there  is  some  peripheral  limiLition 
of  the  held  of  vision.  All  the  negations  mentioned  in  connection  with  the  preceding  case  might 
IK!  repeated  in  reference  to  this  one. 

The  disease  had  progressed  steadily  and  evenly,  but  not  v,  rv  rapidly,  up  to  within  fonr- 
teen  months  prior  to  death,  which  occurred  in  1897,  when  symptoms  of  pulmcmarv  tuljer- 
culosis  made  their  appearance  and  advanced  to  a  fatal  termination.  Apart  from  the  weakness 
incident  to  Ihe  intereurrent  disease,  the  patient  was  aUe  to  walk  without  assistance,  feed  and 
dress  himself,  rend  ordinary  print,  and  easily  make  himself  understood  in  eonversalion,  up  to 
the  end.  The  knee-jerks  were  much  more  niarkeilly  exaggeratwl  and  ataxv  of  all  voluntary 
movements  were  inon-  pronounced  than  when  the  case  was  first  reported.  There  was  at  no  time 
any  mental  detect,  diplopia,  disorder  of  general  sensation  of  the  special  senses,  except  vision,  or 
the  sphincters,  nor  was  there  any  muscular  atrophy  or  trophic  changes. 

If  intereurrent  disease  had  not  intervened,  it  appears  to  me  reasonaWe  to  assume  that  in  a 
few  years  this  case  would  have  advanced  to  a  condition  of  utter  helplessness. 

Incidentally  Case  XIX  died  from  simple  exhaustion  within  the  i>resent  year,  all 
the  Bj-mploms  originally  cunmerated  having  greatly  advanced  and  no  new  ones  having 
been  added. 

A  son  of  Case  XVI  has  well-marked  symptoms  of  the  disease,  which  first  appeared 
nl  the  age  of  eighteen,  five  years  before  I  examined  him  last  year. 

Many  thanks  are  due  Dr.  R.  L.  James,  of  Blue  Island,  111. ;  the  family  of  b<ith 
patients,  for  reporting  to  me  their  condition  from  time  to  time,  and  for  assisting  at 
the  autopsy  in  Case  XVIII ;  and  to  Dr.  C.  L.  Minor,  of  AsheviUe,  N.  C,  for  holding 
the  autopsy  in  Case  XX. 

THE  ANATOMICAL  FINDINGS 
The  brain  and  cord  of  Case  XVIII  were  hardened  in  Holler's  fluid  and  sent  in 
this  from  Chicago  to  Baltimore,  where  this  study  was  begun.  The  tissues  fr.im  Case 
XX  were  removed  by  Dr.  Charles  L.  Minor;  the  mass  of  the  brain  aud  cord  was 
hardened  in  formalin,  but  special  pieces  of  tissue  were  prejiared  in  a  series  of  fixing 
reagents,  at  my  suggestion.  I  wish  here  to  express  my  sincere  thanks  to  Dr.  Minor 
for  the  care  aud  fidelity  with  which  he  fo  owed  out  all  the  details  of  these  suggestions. 

,'!55 


10   DEaoBiPTius  Of  Bbais  jlso  Spixal  Cord  is  Hereditarv  Ataxia 


The  tissues  ..f  these  cases  represent  material  so  rarely  available  that  it  has  seemed 
to  me  desirable  to  put  on  record  a  rather  full  account  of  the  general  morjihology  of 
the  specimens,  so  that  other  investigators,  dealing  with  similar  cases  and  wi«hing  to 
compare  them  with  these,  may  find  in  this  article  a  sufficiently  detailed  description. 
For  this  reason  a  description,  which  might  otherwiso  have  seemed  unnecessarily  prolii, 
will  be  justified. 

DESCRIPTWN  OP  MORE  ADVANCED  C.\8E  (C.4SE  XVIII  OF  SANGER  BROWNS  SERIES) 

CEBEBBU.M   OP  CASE   XVIII 

HEMISPQ£RIC]1    D^iTBVM 

(Fins.  S.  fl.  7.  11) 

PiMCRA  SiLvii.— Distance  from  ramus  anterior  kirizontalis  to  ramus  posterior  usoendens, 
6.5 cm.  The  ramus  anterior  horizontalis  is  2cm.  long,  niuchinB  to  within  0.8 cm.  of  the  buIcuh 
frontalis  inferior.  The  riimus  anterior  asceiidens  is  rudimentary  in  ruulity,  thouBh  at  first  sight 
It  would  appear  to  lie  well  marlted.  On  close  eiamiuation  it  is  seen  that  what  appears  to  bo  it 
IS  a  sulcus  which  anastomoses  al»ve  with  the  sulcus  frontalis  inferior,  and  superficially  below 
with  the  fissure  of  Sylrius,  though  it  d«-s  not  cut  through  the  oi»!rcular  margin.  The  real 
ramus  aacendeus  is  situated  just  liehiiid  this  and  is  scarcely  visible  from  the  surface.  It  makes  a 
small  incisure  only  between  the  pars  opercularis  and  the  pars  triangularis  of  the  gyrus  frontalis 
inferior. 

The  fissure  of  .Sylrius  bifureates  liehiud  into  a  ramus  posterior  ascendens  2.8cm.  long  and 
a  ramus  posterior  desi.endena  12am.  Ii.n^'.  A  sulcus  sulx»ntralis  posterior  makes  a  superficial 
anastomosis  with  the  fissura  Sylvii  behind,  as  duos  a  sulcus  subcentndis  anterior  in  front  of  the 
central  gyrus. 

ScLcrs  cESTBALis  [RoLANDi].— The  medial  extremity  stops  0.8  cm.  short  of  the  medial 
margin  of  the  hemisphere,  1  cm.  in  front  of  the  incisure  sulci  cinguli.  The  lateral  extremity 
terminates  in  an  obliquely  placed  basal  piece  L.'icm.  long  which  runs  parallel  to  the  sulcus 
suljcentralis  anterior.  In  its  upper  part  the  sulcus  is  superficially  connected  with  the  pars 
medialis  of  the  sulcus  {jostcentralis.    Otherwise  it  forms  no  anastomoses. 

Relative  length ,7    cm. 

Alisolute  length 34  cm 

Inclination  of  furrow  with  Hssara  lungitudinalis  cerebri     72' 
Neither  genu  is  well  marked. 

SoLcis  pbj«:e»trai.is.— This  is  distinctly  dirided  into  a  pars  inferior,  a  pars  superior,  and 
a  pars  medialis. 

Para  inferior.— Tbh  forms  almost  a  semicircle  with  concarily  backward.  The  lower 
extremity  cuts  deeply  into  the  pars  opeicularis  of  the  gyrus  frontalis  interior,  almut  midway 
between  the  sulcus  diagonalis  and  the  sulcu.s  sulicentrnlis  anterior,  ending  1  cm.  from  the  fi.isura 
Sylvii.  The  upper  extremity  curves  backward  into  the  gyrus  centralis  anterior,  just  below  the 
gyrus  which  connects  the  gyrus  centralis  ante'i.^r  with  the  gyrus  frontalis  medius.  A  deep 
ramus  anterior  passes  forward  and  upwarc'  .  .0  the  gyrus  frontalis  me<lius.  The  pars  inferior 
communicates  superficially  about  its  middle  with  the  sulcus  frontalis  inferior,  though  a  deep 
annectant  gyrus  separates  the  two  sulci  iu  the  depth. 

Pars  siiperior.~Ua  lateral  extremity  begins  iu  a  short  sagittal  piece,  placed  just  abo™  the 
gyrus  connecting  the  gyrus  centralis  anterior  with  the  gyrus  frontalis  medius.    The  sulcus 

366 


Lrweliyb  p.  Babkbe 


11 

Mtond.  trBn.ver«,ll,-  imHjUl.ar,!  for  84irm.,»heD  it  is  i„tem,pt«i  l.y  an  >,m™t„„t  ifvn.. 
«xte«l,„K  between  heBjn.»  tm„t„li» ,„p.ri,.r  „„d  the  gyn,.  .^ntmli,  nnterior.   At  fte  j  ,„Tn 

/'flr»mrffa!i..-A  tran,ver«,  .ulcu,,2cm.  long,  .ituated  a  little  anterior  to  the  upper 
part  of  the  pars  superior  and  parallel  to  it.     It  gi.m  off  a  ramus  Mgitlali,  p^terior.  2en,.  long 

cenlrali..    No  part  of  the  .olcn,  prajcentrali,  reaches  the  medial  margin  ot  the  hemisphere 

Shlccs  racTALls  l»rtElo..-Il  begins  behind  in  the  pars  inferior  of  the  sulc,,,  pm^-ntm- 
hs,toB.tendtorw„r,if„radi,tanceof  2.4cm.,  to  ix,  intermp.,,1  there  by  a  snperlidal  anLtanl 
gjnrs  exlendrng  from  the  par,  triangularis  of  the  gjrus  fn,„tan,  inferior  to  he  gyru.,  sZlZ 
inedms.  I  anastotnoses  below  with  the  sulcus  in  the  posterior  part  of  the  pars  trianKnkn' 
(fahs,  antenor  .»e„d,ng  ramus  of  the  Sylvian  fissure).  At  its  t..mJnation  behind  the  anrt  m 
gyrus  ,  enfoned,  it  turn,  upward  to  anastomose  with  one  of  the  segments  of  the  sulcus  fronta- 
lis med,u.s  In  front  ot  the  anuectanl  gyn,»  Is  a  transversal  sulcus  2  cm.  long,  th  low^rt 
of  which  Insects  the  pars  triangularis.  This  is  pral„bly  to  1«  regard,^  as  the  sulcus  radiZ, 
of  El«rstaUer.  Running  sagittally  forward  from  its  middle  and  curving  around  thrgy  us 
between  it  and  the  upper  extremity  of  the  ramus  horizontalis  of  the  Sylvian  Assure  is  a  sulciL 
which  ends  m  front  in  another  obliquely  plac«l  transversal  siUcus,  which  is  to  be  regar^^  " 
tho  lateral  segment  of  the  sulcus  fronlomarglnalis  of  Wernicke  Bumeu  as 

™  .^"•■";"  •■•f"'-"  »"':«'"»--n  tegins  behind  in  a  pars  superior,  2.Scm.  from  the  media] 
margin  of  the  hemispher;-.  It  passe,  forward  for  8J)cm.,  wher.  it  is  cross,,!  almost  ^^hi 
angles  by  a  transversal  sulcus  connect.^  with  the  complex  of  the  sulcus  frontalis  melius  nie 
sulcu,  here  make,  a  slight  jog  lateralward  and  is  continued  for  2cm.  farther  forward,  n'hen  it 
turns  sharply  mc^ialward  to  end  1.4  cm.  from  the  m^nilal  margin  of  the  hemisphen,.     In  Iron"  o 

v±rT  ,"'"'  "'°  °'«"""','"'""  ""'""'""  '™'°™'(>'i"«li».«-  l»o  Li, oriels. n,ns- 
versally  placed  compensatory  sulci.    At  the  point  where  it  turns  medialward,  the  sulcus  fronta- 

medT"'  ''°*'*°°"^''  "■'"'  °  ''^«™"i''  ™l««  "kich  is  one  «,gment  of  the  sulcus  frontalis 

.!,•  .'*'^"-™'  ™™"'-"  ■«:i.n:s.-In»tead  of  the  lypicil  sagittal  sulcas,  so  frcjuently  met  with, 
this  hemisphere  shows  two  transver«.lly  placed  sulci,  a  sulcus  tmusversus  frontalis  posterio 
and  a  sulcus  Iransversus  frontalis  anterior  such  as  Teuchini  and  Mingazzini  describj^  The 
former  anastomose,  above  with  the  sulcus  frontalis  superior  and  ends  iXv  close  to  the  sulcus 
frontalis  mfenor,  the  latter  anastomoses  above  with  the  sulcus  fixjulalis  superior,  sends  a  short 
antenor  .apt  a  ramus  into  one  of  the  compensatory  sulci  in  front  of  the  sulcus  frontalis 
upenor,  and  lateralward  b  fiu-cates.  The  supc™  limb  of  bifurcation  runs  backward  l.eZd 
he  gyn«  frontalis  mcdio-mferior  to  anastomos,  with  the  r  .-  frontalis  inferioi,  the  anterior 
limb  terminating  in  the  gyrus  frontalis  medias. 

ante/''  ''  "."','"'":7."  ''  °'  ">"  "'^•'^"'"O'^"  'jpe,  th,,  .ng  no  .subdivision  into  par, 
antenor,  pa^  intermednis,  and  pai-s  posterior.  It  begin,  in  front  bi.low  the  genu  corporis  calL 
the  gyrus  fomicatns  intervening,  but  it  d,»s  not  mich  as  far  as  the  "carrefour"  of  Broca 
It  runs  more  or  less  paraUel  to  the  corpus  «,llosum,  and  leaves  evervwhers  between  it  and 
that  structure  a  brmd  gyrus  cinguli.  Behind  the  lobulus  parac-ntralis  it  curve,  upward  to 
the  margin  of  the  hemisphere  and  cut,  into  the  fades  convexa  for  a  distance  of  1.2  cm  It 
gives  oil  two  deep  radial  rami  into  the  medial  surface  of  the  gyrus  frontalis  superior^  one,  a  li'tle 
behmd  the  level  of  the  sulcus  fronto-marginalis,  reaches  the  medial  mai^in  of  the  hemisphere 
and  extends  for  a  few  mm.  upon  the  fades  convexa;  the  other,  1.5  cm.  in  front  of  the  level  of 
the  pars  superior  of  the  sulcus  pra«eutralis,  just  reache,  the  medial  margin  of  the  hemisphere. 

367 


12    Debobiptki-i  of  Bbai»  and  Simsal  Coku  in  Hebeuitabv  Ataxia 


«itiint(Hl  in  thflparnnperculiLrirtof  thegjnu 


Si-i^cs  ni.rAtTOBiin.-  It  ia  nituBled  enlirelj  upon  Uw  orbital  nurfuco  and  praKnln  no 
uniuunl  fentiinti. 

St'Lci  o»BiT»i.E».~Thommu»lalornll«nn(rtiimu»intennediu«iiret«olonK,  dwp  furro.™ 
nmninir  nearly  parallel  to  coih  other  throughout  nlmo«t  the  entire  extent  of  the  orliilal  .urfai-e. 
Ihe  Biilcua  orbitall.  tranavemiA  i,  Inlermph-d  i,y  them  behind.  In  front  of  their  anioriiir 
extremitie.  19  a  ciirrd  trnnsvenuil  eomiiennatory  wleiis  •itiiati'd  jii.t  at  tlio  margin  of  the  orbital 
iurfaee.  Tho  ramua  medUli.  is  but  feeljly  develop.Hl.  The  medial  part  of  the  »,ilcu»  orbitalia 
trannrenus  la  deep. 

AooEaaoRT  si-lci  or  LOBca  kontalis: 

1.  SitlcU8diagonaUaoperculu—l.H  cm.  loiiff; 
(rontalia  inferior.    It  forms  no  auaatomoaes. 

i.SHlcmfronto-maroim,li,of  We  «.•.(,..- It  iaentirely  K-parat.xl  from  »..Kmenl.  of  the 
■ulcus  frontalis  m«lm».  and  is  rppreaente.1  ,  ,,  y-«hap.^  .ulcus  complex,  tho  stem  of  the  * 
being  directed  baekwaid  into  the  gyrus  frontalis  mi^lius.  The  medial  limb  of  the  Y  mas 
almost  transversally  toward  the  medial  margin  of  the  hemisphen-.  and  n™r  it  undergoes  tripar- 
tite .uxliviston  The  Intend  limb  of  tho  V  passes  Migittally  forward  and  also  divid™  Into  three 
parts,  the  luiddle  linnich  cutting  into  the  orbital  surface.  The  nimt  lateral  segment  of  the 
aulciia  baa  bi^-n  deacriM  along  with  the  sulcus  frontalis  inferior  of  tho  sulcus  radiatus. 

.  Siii<-ii«/,-oi.ta/i».„«(;n(i«.^Thi8«ulcushastnowll-markedsagittal  segments.  The 
mote  posterior,  1.7  cm.  long,  ends  anteriorly  in  a  transversal  piece  1.5  cm.  Ion,-.  The  more 
antenor  ai-gment  is  2  cm.  in  U'ligth,  and  gives  off  a  short  medial  and  a  short  latend  ramus.  In 
front  of  It,  bettveen  it  and  the  sulcus  trnnsversus  frontalis  anterior  of  tho  sulcus  frontalis  medius, 
18  a  short  compensatory  transversal  .ulcus.  The  ramus  posterior  of  the  p,irs  niedialia  of  the 
sulcus  prwcentralia  is  almost  in  a  line  with  the  sagittal  «igmenl  of  the  sulcus  fionlali. 
medius. 

4.  S„;™«  mslmm.^A  deep,  Kellmarked  sulcus  running  for  some  distance  parallel  to 
he  anterior  part  of  the  sulcus  cinguli.  It  then  turns  forward  and  nins  to  the  medial  margin  of 
he  hemisphere,  to  an.^stoina«e  there  with  one  of  the  branches  of  the  tripartite  aubdivisiona  of 

the  medial  segment  of  the  sulcus  frontomargimilia.     There  is  no  sulcus  lostralis  inferior. 

lietween  the  two  radiating  rami  of  the  sulcus  cinituU  is  a  long,  deep,  sagittal  sulcus  on  the 

medial  surface  of  the  gyms  frontalis  superior.    It  gives  off  a  number  of  short  rami  into  the 

substance  of  the  gyrus. 

i?-LCfs  PA»ACE.VTaAus.-  About  the  middle  of  the  lobus  paracentralis  a  vertical  ramus  from 

the  sulcus  cinguli  cuts  into  the  substance  foradistanceof  I..';  cm.    In  front  of  thia  there  is  a 

J-shaped  depression  and  behind  it  a  V-shaped  depression  in  the  siu-face. 

SCLCCS  INTt  IPAKILTALIS: 

I.  Sukm  pmlcenlmlts.-  This  sulcus  is  divided  into  three  segments  :  (a)  a  pars  inferior, 
(i>)  a  para  mtermedms,  (c)  a  pars  superior. 

The  jwrs  inferior  is  an  oblique  segment  2.B  cm.  long,  cutting  into  the  gyrus  supramar- 
ginalis  above,  and  slightly  into  the  gyrus  centralis  posterior  billow.  Near  its  lower  extremity  it 
anastomoses  with  the  well-marked  sulcus  suhcenlralis  posterior  of  Marchand 

Thepors  .nfermerfius  8.3  cm.  long,  runs  almost  parallel  to  the  sulcus  centralis.  It  is 
imitedljelow  by  a  gyrus  connecting  the  gyrus  supramarginalis  with  the  gyrus  centralis  pos- 
terior. Above,  It  cuts  mto  the  gyrus  centralis  posterior,  and  a  little  above  its  middle  it  anasto- 
moses with,  or  gives  rise  to,  the  sulcus  interpanetalia  proprius. 

The  par>  superior  is  curved  some ..  hat  Uke  the  letter  s.  Its  medial  extremity  is  situnted 
behind  the  mcisura  sulci  cinguli  -nd  leaches  to  within  0.7  cm.  of  the  margin  of  the  hemisphere. 
The  sulcus  IS  markedly  convex  'orwaid  about  its  middle.    Just      low  thia  convexity,  a  short 


LEWEiLva  F.  Baiiiei 


ja 


fritnillii  pmlerlor,  eoniiw;!.  IW  inn  iiiip,rior  with  the 


naglttnl  Hulcufl,  cutting  ncroHn  the  Kjnw  c 
upper  part  of  the  mileiw  centnlu. 

2.  ««(,„.  iul,r,Hin,lali.  ,,mprii„.  It  l^-Rin,  ,  little  nboTe  the  rai<l.lle  ot  the  pan.  ioterme. 
dlu.  ollhe  .ulcu.  pctoentnili.,  ami  eileml.  in  a  curve  Imckwaitl  and  in«liahva«l  1,.  terminateO  5 
cm  m  fron  of  the  anterior  li.nl,  o(  the  U  formed  by  the  .ulcu,  p„r,«-cipitali».  At  the  jum-tion 
of  its  niid.llB  and  posterior  third,  it  give,  off  a  ramu,  ni«liali.  which  extend,  to  the  miiritin  of 
the  hemi.phc.1.,  and  makes  an  nnaslomoei,  with  one  of  the  sulci  in  the  pm<:unen..  Thi.  nirnu. 
medlahs  pre,  off  a  short  sagittal  branch  which  pa.«..  forward  and  account,  for  the  markul 
antenor  convexity  of  the  middle  of  the  par,  .uperior  of  the  .uleii,  |,„tce„trali,.  Beloiv  th.. 
•ulcus  interparietali.  proprius  ana,toiuo.e.  with  the  .ulcua  lnterm«liu»  prim,.,  of  Jen«.n  an<l 
al«>gir™off(n)ar«mu»which  runs  into  the  gyrus  .upramarginali,  to  end  blindly  in  that 
gym.  and  (6)  a  ramii.  which  extend,  into  the  gyru.  angularis,  p,„«,  through  it  running 
'i^^or"™  iutenncdiin.  primus,  to  «na,tomo«,  with  the  sulcu.  teml^rZ 

inten!';rie[l'r''^7'"''''';^''"°'^r''*'-~.'''""'''"'^*''""''^'™™'''°'^^    "'  "»  -l"^^'" 

cuttrih  r      *"  ZT^ " ".""""'  "■"  '"'^'°° "' "'° «»"""'  p"*io,x.«pi.„ii,  which 

wHhiro.™  Mr"""T-  ."■""■"""'"'"'-ityo'  Ibe  anterior  limb  of  ,1.,,  u  reaches  ,„ 
M^^t  lli        ;  T*^"  "»  •"■  '""""'''''"O-     P"'"  "-e  latter  extremity  of  thi,  limb  a  n„„u, 

extremity  of  the  sulcu,  inlerpanetnlis  propriu,."  The  po,lerior  limb  of  the  u  bifurcati.,  a, 
it  approach™  the  margm  of  the  hemisphere.  It  form,  no  ana,tom.»i,  with  the  sulcu.  occi- 
pitalis  tnin^verHUs. 

Scurs  PiaiEWLis  srpERioa.-Thi.  sulcu,  run,  nearly  tnnsver«dlv  on  th.-  fiici™  convexn 
being  .ituaW  W»i«,n  the  anterior  limb  of  the  u  of  the  sulcus  pa«,-c'ipit,di,  l,.hiiid  and  the 
rnmu,  m«liah,  of  the  sulcu,  interparielali,  propriu,  in  front.  It.  kteral  extremitv  i.  cum,!  a 
httlc  for-vard.  Mcd,Ml„„rd  it  run,  to  the  margin  ot  the  hemiapheie  and  ana,tom<^»  with  sulci 
on  the  surface  of  the  pra-cuneus. 

„.„, ^'"^r  »"■■*«""■•■»■  -This  sulcus  i.  reprmentcl  by  two  segment..  The  anterior  seg- 
ment anas  omo«,.  m  front  with  the  sulcus  cingnli  and  behind  turn,  up  and  anastomose,  with  a 
lertical  .ulcu,  pra-cunei.  The  posterior  segment  is  shallow  and  im-gular.  It  i,  limited  Ixiind 
by  a  gym.  which  connects  the  posterior  part  of  the  pm-cuneu.  with  the  gvru,  cinguli 

SCLCI  p».ECf.vEl.^Theprwcuncu,pn«eutathre.  ilci  one  anterior  vertical  sulcus  and 
two  antero-postenor  sulci.  The  anterior  vertical  sul.  anastomo^.,  K-low  with  the  anterior 
segment  of  the  sulcus  .ubpanetali,  ;  it  ran.  backwar  m'  upward  to  the  margin  of  the  hemi- 
sphere to  form  a  superficial  ana,tomosi.  with  the  ramus  mediall.  of  the  .ulcus  interparietali, 
proprius.  fhe  two  anteroposterior  .ulci  divide  the  part  of  the  pr««uneu,  behind  the  vertical 
anlelre  L  r  '",!!'  If'  '^."^  '^''  fP""^'  aute».po,terior  sulca,  ana.stomo«,s  at  it, 
anlenor  extremity  with  the  .ulcus  panetali.  superior  which  i,  continued  upon  the  medial  snr- 
race  oi  the  nemisphere. 

with  f ''"*  ■•"aiETOi^iPi^u.,.- Distance  from  medial  margin  of  hemisphere  to  anastomosis 
wi  h  fl.,nra  oleanna,  3cm.:  extent  upon  facie,  convexa,  2.2cm.  On  the  m«lial  .surface  near  its 
upper  part  it  anastomoses  with  the  upper  anterior-posterior  surface  of  the  priecuneus  This 
corresponds  to  an  ana.tomoei,  »-ith  a  sulcus  on  the  .uperiicies  posterior  lobi  parietali.  of  the 
brother  .  brain.  This  brain  ha,  Ix.™  hardened  in  MMler',  Huid,  and  the  li.sura  cinnot  be  opened 
so  as  to  permit  of  the  examination  of  the  posterior  surface  of  the  parietal  lobe. 

FiSSCRA  CALCABINA: 

Lenffth  of  truncus 3.5  cm 

Length  of  fissura  propria 3.3  cm! 

3S9 


14    Dbiioipviox  or  B»ai»  and  Bpikal  Co»d  in  Heieditabv  Atama 


I  «iia»lo,nn.,.,  l,.hin.I  with  a  .uluu.  which  piu,«-,  downward,  cultlnK  oBf  a  i^irlioii  which 
othiTww,  «„iiM  l„  0  part  o(  the  gvnw  llnfc. .all«  h..lmt.|i  It  niiil  the  puliu  ottipitnli«. 

Sita-t  occirETALM  mAwvEMcA.  -  AUivo,  It  Ix'giiiA  4  iiii,,.  l»hlnd  tho  p<»t.Tiiir  lljiili  of  the 
•iiloiiA  piimre.plUill.,  but  l,  coiiipfetely  «.i«iratod  from  It.  It  pa«™s  tnin»v..r™llj  dnwuwiird 
and  a  littio  Imckwiinl  to  Biia«tiimi»«)  witha  i.uk-ii»  running  at  right  angli.»  to  It. 

S,ur  ocapiTAiM  icpiaioiu.  -Thu  .urface  I,  raarkwl  by  .light  deprumlon.  :  th.T..  nns  no 
donnitf  Hulci. 

SiLii  occipiTAi-n  LATERALS.  -  Thpro  i»  ouo  lateral  .ulcu«,  running  from  a  point  jui.!  above 
thi- polu.  mxipllalia  forwa.,1  and  dowuwanl  to  the  Inferior  mirfaii,  of  the  h.mi»i>hi.n.,  IhiTO  to 
form  th.-  |K«tim.tat.Tal  limb  of  th..  H»haped  >ulcua  comply.  Behind  tho  1ow,t  part  of  the 
sulcus  ivc-ipilahs  IransversuA  a  short  >ulciw  ruiH  Imckwanl  and  downwanl  (almoKt  at  right 
angles  ti,  tho  coiu^w  of  the  sulcus  occipitalis  trausversus). 

Siu;iaTE»po»Ai.»!i-PEMoB.-It  begins  in  front  and  a  little  below  the  polus  emporali. 
and  runs  backward.  The  gjrus  temporalis  suix-rior  is  very  nan„w,  aveniging  less  th.,n  1  cm.  In 
thickni,..  The  sulcus  curves  downward  in  Its  p,wterior  part,  owing  to  the  ramus  posterior 
descenden,  of  tho  Sylvian  assure.  Behind  this  tfgi.  u  it  agiiin  runs  backward  tor  a  distance  of 
i  cm.  and  then  turns  sharply  upwanl,  curve,  a  little  forw  ird  and  ends  by  a.i-stomo«ing  above 
wi  h  tho  sulcus  intorparielalis.  In  this  part  of  its  course,  tho  sulcus  runs  alm^  «t  parallel  to  tho 
sulcus  lnt<'rmodius  primus  of  Jensen,  and  between  the  two  is  a  transvemally  placed  gyrus,  cut 
off  fmm  the  anterior  portion  of  the  gyrus  a-'gularis. 

Sfuvs  TEkpoBALis  HEDics.  -The  bmiu  has  b.«n  a  long  time  in  MttUors  Juid  and  h.i« 
become  bnttlo  Portions  of  the  surface  in  the  region  of  the  seVus  temporalis  mediim  have 
been  broken  off,  and  the  detaiU  with  'ogard  to  tbhi  sulcus  ate  obscun.d.  It  appears  to  ran 
sagiltally  iMckward  for  a  distance  of  about  8  cm.  and  then  to  be  Interrupted.  Tho  sulci  in  the 
lobidus  panelidia  Inferior  ate  well  preserved,  as  are  those  in  tho  posterior  portion  of  the  |.  •unoral 
lol»  The  arrangement  U  peculiar.  Behind  the  terminal  part  of  the  sulcus  tem|ioraliH  aperior 
and  lielow  the  sulcus  interpariolalis  and  in  front  of  the  .ulcus  occipitalis  transversus  is  a  hirge 
more  or  less  triangular  atea  of  brain  surface.  Within  it  is  a  Vshaiwl  sulcus  comtjoi  the 
stem  of  the  V  (below)  corresponding  in  all  probabUity  to  a  segment  of  tho  sulcus  temporalis 
medras  (Elierstaller),  i.  «.,  to  Wernicke's  sulcus  occipitalis  anterior.  The  anterior  limb  of  the  V 
corresponds  to  the  continuation  of  the  stem  and  represents  the  sulcus  about  the  eitremily  of 
which  the  gyrus  angularis  winds.  The  posterior  lunb  of  the  V  is  tho  sulcus  about  which  the 
lobulns  panetahs  posterior  Inferior  Is  situated.  Cutting  into  the  middle  of  the  area  from  .ibove 
IS  a  short  di^ndmg  ramus  from  tho  sulcus  paroccipitalis.  This  apiran.  to  be  tho  representa- 
tive of  Eberstallor's  sulcus  intermodius  secundus,  as  it  separates  the  gyrus  angularis  in  front 
liom  the  lobulus  parictalis  posterior  inferior  behind. 

Sulcus  texporal.s  i-ipEEioa.-  It  begins  in  front  2.4  cm.  behind  the  polus  temporalis,  is  s 
shallow  sulcus  and  is  interrapted  by  a  gyrus  which  connects  the  gyrus  temporalis  inferior  with 
the  gyrus  fusiformis.  Behind,  a  segment  runs  on  the  inferior  surface  for  a  distance  of  4  cm  ■ 
opposite,  about  the  middle  of  this  segment,  is  the  incisara  formeriv  callwl  the  incisura  pne- 
oocipitaha.  It  leads  into  an  H-shaped  sulcus  complex  in  tho  lower  part  of  tho  temporal  lobe 
Tlie  posterior  superior  limb  of  this  complei  passes  upward  and  anastom  .ses  with  a  sagittal' 
sulcus  which  runs  forward  fl«m  the  lower  end  of  the  sulcus  occipitalis  trans -ersus  to  cut  deep 
into  the  gyiustempornlia  modius. 

Fissc»Acoi,LATEBAUs.-It  bogius  closo  behind  the  flssura  rhinic;,  which  is  here  only  a 
shallow  incisuxo  and  does  not  communicate  with  it.  Its  greatest  convcsily  medialward  com- 
spends  to  tho  insertion  of  the  tip  of  the  gyrus  lingualis  into  tho  gvrus  hippocampi  Around 
its  posterior  eitiemity  an  annectant  gyrus  passes  from  tho  gyms  hngualis  to  tho  gyrus  fusiformis 


I 

■ 

I 


LewilitbP.  Baiiei  15 

Th«  gym.  llDgiiali,  I.  Im«ukrly  xroovrf  bj  lhr«;  .ujd.  The  larp,!  !».«!„.  „™r  ll>.,  „,«!..  of 
'.,..clionot.holl,»umc«Icarina»lth  II.  Iranou.  „p,l  ni,„  dowimnnl  ,m,l  lm-k».ml.  m»l  th,  n 
toemlwanl,  l»  form  th.  pcWrior  Inf.rior  llml,  „l  it..  H-.hiiM  -ulcu.  i-eimplc,  n^f.™,!  lo nt 
Uio  po.t..rior  pnrt  of  Ihe  temporal  l,il«..  Pu..in»  out  of  Ihi.  .ulru.,  anil  iit  rlitlit  niiKln  to  It 
m  two  .hallow  .ulcl  which  anutomow  In  front  with  th»  pcterior  part  of  tho  Uasura  colkteiali.. 

DEMiaPBAIiril    HntlSTBCM 
iTtn,  «.  S.  1.  9, 10) 

FiMr«A  CE>n«i  LATiuua  [Sti.71,]— The  ramu.  anterior .«»n<I..M  and  the  rarnu.  anterior 
horizontalwcome off  frou.  the  mniu  ll«»im,  l,ja  comnwn  .tern  1.4  mm.  loii».  Thi.  .Inn  biluTO.t™ 
ami  the  mmu.  anterior  horiraitali.  proper  I.  1..1  mm.  low,.  The  rai„„.  anterior  a^^enden,  i. 
l.li  mm.  lou({.  The  par.  triaiwiiliiri.  of  the  ujnw  fronlali.  luf.ri.ir  i.  Ihii. iliminutivc  Thi. 
appear,  to  l>e  In  part  due  to  the  ve-.jr  marked  development  of  ll,"  .„l,u,  diuKoi.uH.  whk-h  cut. 
very  deep  into  Ihe  par.  opereulari.  aod  the  lower  part  of  Ihe  lutt.  i  I.  driven  deep  Into  Ihe  fo.™ 
sylvu. 

SuLccscisTaALU.  -The  lateral  eitremlty  ana.lomo««  with  a  very  well  mark.»l  .ulctia 
.utwrntrall.  anterior.  The  latter  i.  2  cm.  long  and  make,  a  .uperiiml  ana,tomo.i-  IxOow  with 
the  nH.ure  of  Sylviiu). 

Cutting  Into  Iheopeteulum  from  lu  front  lu  a  direction  at  right  angle,  lo  Ihe  .ulciw  .uli- 
centrali.  anterior  I.  a  little  .uicn.  which  .'oe.  not  appear  to  have  been  hithe -to  d..«ril«l  It 
l..ltunt.^  jiwl  .lelow  the  in«rtio"  of  the  root  of  Ihe  gym.  fioulali.  inferior  into  Ihe  gvru. 
centmll.  anterior. 

The  .ulcus  centrali.  prewnt.  about  it. middle  a  knee projectng  forward,  due  lo  an  imisura 
into  the  gyrii.  centrali.  poaterior  from  the  .ulcu.  poetcenlmli.. 

A  «.eaiid  .mail  knee,  due  to  a  .imilar  cauae,  i»  m-n  l.r,  cm.  from  the  m«linl  margin  of  the 
hemi.ph  jre.  The  medial  extremity  of  the  .ulcu.  reaches  just  to  Ihe  medial  margin  of  Ihe  hemi- 
.phero  and  does  not  pas.  over  upon  the  facie,  medlali.. 

Inclination  of  .ulcus  ceL  :Bli.  lo  hHBUra  lonaitudinali. 

cerebri  70- 

Relative  length 7.7  cm. 

Abralute  length 97  j.^ 

Other  than  that  with  the  .ulcu.  .uboentrnli.  anterior,  the  sulcu.  centrali.  form,  no  anaalomowa. 
Slices  PBAicESTBALu.  -  This  present,  for  eiamiimtlon  three  portions:  a  par.  inferior  a 
pars  superior,  and  a  par.  medialis. 

1.  Para  in/«rior.  — This  form,  an  X-.hape<l  complex,  the  anterior  superior  limb  of  the 
X  being  the  ramus  a..terior  of  Eberstaller.  the  posterior  interior  limb  a  ramus  posterior  passing 
beneath  the  inserllou  of  the  root  of  Ihe  gyms  frontalis  medius  into  the  gyms  cratralis  anterior. 
The  other  two  limb.  0.'  the  X  leprewjnt  Ihe  main  direction  of  Ihe  sulciLs.  The  li,lteris4cm 
long,  the  ramus  ai-lerior  2  cm.  long,  and  Ihe  ramas  posterior  1.3  cm.  long.  The  oars  inferior 
anastomose,  near  its  lower  part  with  the  sulcus  frontalis  interior. 

2.  Pars  superior.  —  It  is  2.8  cm.  long  and  •■  ov(  taps  "  the  upper  part  of  the  pars  inferior 
in  the  greater  part  of  its  extent,  being  situated  behind  it  and  separated  from  It  l.v  a  superficial 
gyms,  a  part  of  the  gyrus  frontalis  mediu...  Near  it.  upper  or  meiMiU  extremity  i'.  gives  origin 
to  the  sulcus  frontalis  superior  which  passes  forward  at  riglt  angle,  to  it.  Its  nie<lial  extremity 
is  wjparated  from  Ihe  pars  medialis  by  an  anoectant  gyms  which  connects  the  gyrus  troutalis 
superior  with  the  gyrus  centralis  anterior. 

3.  J'ura  merfiafid.  -II  consists  of  an  obliquely  placed  Hsnuped  sulcus  complex,  situak'd 
between  the  medial  extremity  of  the  pars  superior  and  the  medial  margin  of  the  hemisphere. 

861 


'"-i^""'"'  "'  «"'"  "°  ^'-AL  Co.„  ,K  H...P,TA.,  A,AXU 


ilrilllr. 

"I  111.' 


S:ri;n:ri.:i;:;,];;:;:,r.'r'iT?'  "^  r""'  """•'""  -'  * ■■""  •■"■■ 

behind  the  .ulcu.  nntnili.     It  Hn™  „T^^.      !  Ti  lnn"»pli.T..  at  n  |><,iut  2.3  cm. 

.u.„.w.^h.twr.rLi':r.rr;:,/rjr.r^iz„r^^^^^^^ 

th»  .ulcuH  pMtcentrnli.,    The  ,ulcl»  cinmli  in  it.  eoi.r™  Jvlfli  .         f       ""'"■"""  "' 

»M.^..  to™,  the  „«..„  o,  .he  he^jiT t  JZ  nl^'::;\;^  ^^j;- 

p«=ulf«nr.  ""*™"-"-T''«  '■  '"--"l  ™tW,  on  the  orhifl  .urface  and  present,  „„ 

one  ,,„„,h,.r.    ,„  ,„  ,„.„„,  h„„  i.L  <»ntiLuedZ.p  .nn^.,Xt;;tT„  ;i'f  sT'"'""'  '"'■'" 
of  the  orl)itiil  opereulum  > «"  nan  Qimo«l  to  the  hj  Ivian  margin 

..mporah.    The  ,„le„,  ana..omo«»  .  Jve  wi.hVetLjT™tah:ilTcri„:, '"'"'"'"""'  '"""' 

362 


LlWILLTK  F.    BaIIEI 


n 


V.  Sulmn  miUnttm.—Vlile  tuftm. 

X  Hulrii.  frm,l„miirginnlit  ( ilVimWirl.  II  mi»l>t»  nf  lhm>  •rtrimnl'*  -  m«lliil.  mlililli-, 
and  Inl.nil  (i(  nhirli  llio  la>t  lunHil  In  iii<l<'|»'ii<li'iil  „f  llii'  t.lli.p  two.  TliU  lul.ml  i»i.'iiinit 
(fm  '  .riii«  Ihi.  biiwl  liTmllmli)li-cnttli...iiliii.«l,l,.|il».hlii.l  i»  ,'.iiilliiii.ni>  »lth  Ih..  .ulpiw 
fnii  ..!>  liiti-rW.  rh.i  miilliil  (/»..)  iiml  niiilcll.'  (/»>,i  »«m..iil»  r..|,n«iil  tl.,.  liriilx  ..( 
I«tliir™il.in  ..( Ih..  mikiiK  fn.iil«  h  hhkIIim.  Tli..  imillul  ..wraiil  n-.uh..»  t.i  Ih..  iii.ilii,l  iniirKiii 
ot  Ih..  hi.nil«[ihtn-.  mid  lh<.  iiiliMI..  i«Kiii.-nl  .-sLiiih  l.i  wllhln  O."  c.f  lh<.  liil.ral  Uihit.^l  xviiu'iil. 

i  s,flm  frmilnU-  >u..(/,i/i«.  Thin.  iin.  no  ..iiKlllul  i«i[nii.nt»  wlinli'ViT  tu  tli.i  >ulcu». 
iDHtfnd,  IhiTp  .iri.  fiv».  otillqiit'Iy  tmnHViT^nl  w>nnpiil». 

-..  .S»;,  ,„  r.«(,n;,-,.-Thl«  Ik  wll  .l,.,..j„,„l.  It  1,.^„,  l,.hi„,l  |„  Bm<.u',.  ™m.f,.iir  nral 
[olltm.  n ciuir«(  iii-nrly  poniil..)  to  Ihn  lii;nKlii  of  Uii.  b.iiii»i,l,.,n.. t.-niiluiiliiiK iiluv,. »l (Ir. m.^lluj 
iiinrKlii.  i  mm.  U'hinil  Iho  huhIIiiI  lliiili  i.t  Iho  mili'iu  (niiihimurKlniiUa. 

Il..l.,»-  Ih..  tmiiliil  |>iln  niii.tl»'r  •iilra»,  n.pn-«.nlli«  In  oil  |in.l«.l>.:itj  Ih..  .iilra«  fmnt«li« 

Inferior.  l«Kin«.  |.xhinillni;  for  2  i-m..  it|ioi>  11,..  mi.<llnl  mirfim.  of  Ih..  h I.ph.r.'.  Ih.'ii  liiriH  iiiion 

Ihe  fiul...  orlillnll»  ouil  nuia  olilujiifly  t.>rwiml  uiiil  lut..rul»nnl.  ii.l  In  Ih..  iiiilcrlor  i..irl  o( 

that  Kiirfiu'c. 

Hiu  r«  M«»ii»T»ALi»."Thi.  LilmliM  pmrncnlmli.  pnwml.  n  u  .hii|«.il  huIi'iik.  Thf  !»«» 
of  lh»  U  uii.l  lln  iint..ri.ir  linili  un-  (l...|ii  thi.  i»j,terior  limii  of  Ih..  U  l»  v.TV  .hnl]o». 

HrUT»  INTERPARILTALll.: 

1.  .S«l™«j«M(..|«fra/,«.  Thl»con.l,l.oflhnH.«im>.nl.  inf.-rlor,  mio.lh..  aiM  .tiperiop. 
Thi.  infi.nor  .«.((meut  Uoiily  1.5  cin.  1...  ,  and  nlHmt  ll«  midilh.  nnn.torai««.H  with  III.,  •illciu 
n.tt)c«'ntniIiH  lniur.v(.n.uH  ..f  Eli..n.liin.-r.  iK-hlnd  it. 

Th..  luldille  imrtion  i>  4  oni.  loiiif  and  annstoroooi.  ncur  lt«  upper  piirt  «ilh  Iho  aulciu 

mlen«iri..|iin.  propriiw.    On,,  ami  n  half  cm.  nl«ivu  II.  l.„n.r I  it  kI,i'»  oH  a  ramiw  >af{ltlalla 

nnliTuir  which  cuU  deep  into  the  gjriia  ccntmli»  |»,«lerior,  and  mu™.»  a  kniKj  in  Iho  »ulcu» 
centralis. 

The  »up<Tior  or  medial  i»«ment  l«.(rin«  2  cm.  from  the  nu^lial  margin  of  Ihe  h.-ml.pbere 
and  exl..nd»  to  the  marKin  U.|»™n  Ihe  .ulcua  cnlralis  and  Iho  inci.uni  sulci  cinifidl.  Il» 
lateral  extn'mily  curvi.»  forward  Into  the  (jrru.  centralis  posterior.  Alsint  its  ml.hll„  it  (rives  oj 
u  nimim  posterior  which  acts  as  a  compeuMtorj-  sulcus  for  the  incisura  su!ci  ciiigull  ontbe  fades 
convexH. 

2.  nitlem  inlrrimrietalui  pmiiriat.—  It  begins  In  the  upper  part  of  Iho  middle  port',  n  of 
the  sulcus  poslcenlmlis,  and  follows  i>  tortuous  course  ImckwnnI  and  mi.dial,ranl.  D.i,ind  it 
foniis  n  «ui«rilcial  anastomosis  with  the  u  d..scril„sl  l,y  the  sulcus  |Hiroii!ipilalis.  Alrait  nii.lwav 
in  its  course  it  gives  oS  a  ramus  m...lialis  which  nius  mcdUlward  ami  forward  lowanl  lh„  nuMlial 
part  of  the  sulcus  poslcenlmlis.  The  sulcus  int,Tmediu»  primus  of  Jeii.s,.n  passes  lateralward 
from  it  l».twisn  the  gjrus  supmmarginalis  and  the  gyms  angularis. 

3.  S,i(|.««  priroecipilalit.  -This  sulcus  forms  the  usual  U  alionl  the  llssura  pnrietooccipitalis 
of  the  facies  convexa.  The  anterior  limb  of  the  U  reac''  j,  the  m.slid  martfiu  ot  the  h,™i«phen.; 
Ihe  posterior  limb  ot  the  u  does  not.  The  post<.rior  limb  of  the  u,  tog,.|h,.r  with  a  sulcus 
running  Llt,.ralward  from  its  junclion  with  the  foot  of  the  U,  makes  the  sulcus  occipilalhi 
trmnsversus. 

SiLixs  PARIETAMS  scpEnioB.— ll  anastomoees  at  the  malial  margin  of  Ihe  hemisphere  with 
the  sulcus  pni^cunci. 

Scixcs  siBPABliTALis.  — This  BulciM  IS  separated  from  Ihe  sulcus  cinguli  in  front  bj  a 
gyms  1.1  cm.  wide  cxmnecting  the  prii.cuoeu»  with  the  gyrus  cinguli.  It  curv,«  Uwkwnrd  and 
downward  but  is  B<.parat,-<1  behind  from  the  fissura  calcarina  by  a  gyrus  which  connects  the 
pnecuneus  with  Ih"  -'\tus  cinguli. 


Iho  .ulru.  .uhp.riH.ll..      ■IWl»r.™r,?T..  L  "^      ?    T""'  "'"''"•"  '""I"-!- <"•<■"•.  of 
pr-H-m,...  .hir;iZ^  w«  ,»hTh.   *",""*"'"  '"'"'"»•'  '"•'""■I  ''J  •«°  wtld  .„W 

™.„f,w,„.,u„.  jx:?,^.t„";i:^^„:  ■'"""»  -•"'•-"'••'""•  •»«  .•...•»!  .o,i.hi„.i„.., , 

FiuoM  calcarina: 

Longth  of  truacui            ....  -, 

Length  of  HwuK  propria "   -        i?  cm' 

middle  (.ho  co'„ii„,„.,™,':Mi,7;r™';j;i"p^",„'"'i'  s°:t.5-"  ""t""'"""  "■• 

therewith  «.ulra.o«lpltnll,lah.n.ll.  ^'  ■"»'^» '<> ""tonHJM 

fn,„i^;"^.3r^\rrr^St;'t:;,r::e^^ 

la.en,l  extremity  „f  the  ..Ucu«  «,„lpltall.  tZ^Z        ^'  "'    ""'™'  P"""*"' «»  ""> 

of  .he'::;^;,^  iT"  "™"»-'f ""^  ■-  "■■« ""'"« <«l^ .  .^  «„  ,h.  ia.en.1  .^,^ 

pora'i,  ,„p.rlor  1.  nan^w,  beVn^  0.8  to  l"  m  In^d.h  '  ^^^    "■"  ^^  "»■ 

tor,  dt^ptiroTihir.:.™:.  pj-r  °  "■"  '^-'  '"'-"^  -  ""•  ■*  -> "-'  -  »""«■ 

a  iuperiidal  aulou,  connect,  the  .01™^^?  «      !^  »nd  backward  upon  the  facie,  conreia; 
thl.  !^„„.  ""'  """""^  '"■"P""!''  "■«)i'"  -rith  the  .ulcu,  lemporaU.  Inferior  in 

b,in/rrWl7»"rmM7a[:a'^°",.'°.:™lt^t^,r/r^^^^  -"  P««"  backward, 

THE   '  EBEBELLUM   (CASB   XVIIl) 
8M 


LlWILLTH  F.  Baiiii 


19 


UllHtnlnl  In  Fiif.  ».  Th.  dnwlnir  n.  klndl;  nuih  lor  me  by  mj  a-ccM,;  Dt.  D.  O. 
R«i«ll.    The  llDKuh  <«t«Mli  Is  not  «i.|l  prwrnsl  •od  l«  Khomiillrallv  llliistnilMl. 

Thu  lolxilua  cculnilk  tlimi«h  w..|| .IrnloiKil. u  out  «ry  I<iiik  hi  it«  »i.rtk-ol  dlanuln.  II 
doM  DO)  enhr  Inio  Ihi.  f.iniintlon  o(  the  fnd™  miixTior  orivbolli.  Thiro  nn.  mirvD  y(an<iu1l(»(« 
no  ll»  aiihirinr  nurfiKo  nnd  Ave  on  Ita  pontirior  aiirtui'. 

TI--  lumllriiluH,  .ul<llvid<'<l  Into  cul  i  nnd  dreliv,..  U  will  d.v.Oo|»»l.  Ar.  In  llm  linln  o( 
IIm  brolkrr,  ll».  lolnu  lnUrui«dluiHl».|w»  „  lobulu.  cinlnilU  lud  II...  Unlpirtol  tbiculm.  ii) 
1»  iinu.unlljr  »bII  iU.wlop.Hl.  Com|>nre  FI([».aiS  and  »  wllh  SliUlnK'"  Flu.  I  a.  Kniiu  llio 
n-rttalllrab  o(  the  nrlnr  vll»  there  an  eluht  ..ir»hool..  corre-pondlnu  loSllllInK'"*"  tnC- 
( Sllllmif  .  r«(,  (..  ,/r(H,  Wand ),  while  (mm  the  horiiontnl  limb  ot  the  arU.r  viUu  cuui«  off  the 
proj.«tloni.  con™pondln«  to  Stilling'. C- to C"(HtillinK'.  iiVrle  !»<  wdiih  lla.ii/l.  Then. 
•rould  «».ra  to  be  no  nurkinl  alteration  In  the  numlier  and  chnnirterol  the  Jia„rfirti;»(e  on  th.. 
dlffennt  WAndi;  lhou((h  iierhnpx  the  d<'pre«lon>  Utwixn  them  are  nilhor  .halloner  than  mimial. 
The  deep  ■lit  between  the  culmen  nnd  the  d.Hllre  In  conllnuoiw  lut..nil»»r.l  with  1,,..  >ulriia 
which  lepaniln  the  p,ir»  anterior  (rom  Ibe  pnm  po«l<.rii>r  o(  Ih..  UiiiIiih  .|ii».lmnKnliirl..  The 
(ollum  termla  ixinm  ol  (mm  a  terminal  off.hool  o(  the  horiiontnl  |iortlon  o(  the  arbor  titn),  bi 
rvlation  to  the  lowermost  portion  o(  the  devlive. 

The  tuber  rennl.,  well  developed,  l«  arrangiHl  around  one  prilulpnl  ■leui  o(  the  arbor  ilt«., 
which  bKurcatea  Into  tv  o  main  aubdlrUlona. 

Tlwpymmw,  a.  U  usual,  h«  a. Ingle  .lemo(  arbor  ril»  which  bl(urcale.n«ir  the  peripherj 
o(  the  rermis  Inlcrior.  «~   i-      j 

The  uvula  Is  large  and  well  developed;  It  Mema  macnwcoplcally  quite  normal. 
The  nodulus  la  perhiip.  rvlatlveljr  a  little  .mall.  Iml  otherwlwj  pn«nt«  normal  appearancea. 
The  hemiapherea  are  well  developed;  the  Individual  parts  show  the  normal  ohatutxrisllo 
■nacrOTCOpic  arrangeirent. 

mcRcscnpioAi  examisatics  of  case  iviii 
All  the  ti..ue  waa  hardens  '  ii  MOIler'.  Buid,  and  the  microscopical  etamlnallon  hna  there- 
Ion  been  praetlcaUy  lim'ted  to  the  study  of  Welgert  pniparalioiu,  and  carmine  specimen.. 


Paw  lombaus  (Fig.  H): 


KBDCLLA   BPIHAUa 


DIMmstOITB 

Antero-posterior  diameter Ol7  cm. 

Tranavenw  dismetsr      -        ■ O.Si  cm! 

iPndtM.  atileriorea  it  poslwiorM.-Theso  are  small  and  contain  fewer  fibers  than  normal. 

The  connective  tissue  of  the  endoneurium  is  increased  in  amount.    In  the  anterior  roots  a  very 

large  proportion  of  the  fibers  are  amall.    The  number  of  large  fibers  appears  to  1»  diminiahcd. 

Pm  malf  r.— This  la  thickened,  as  In  Ibe  other  case,  measuring  a.  much  as  0.169  mm.  in 

thickness  in  phices. 

•^nipftial  layer  of  neuroglia  or  to-called  "  glial  iheaih." 

Maximum  thickness  opposite  anterior  born  -  0.049  mm. 

Maximum  tbicknsfls  opposite  fueicuius  Isteratis  •  0.8  mm. 
Average   thickaess    over   funiculus   posterior   near 

medislline 0.061  mm. 

Average   thickness   over    funiculus   posterior   near 

entrsnce  of  posterior  root 0.0e3mm. 

Maximum  thickness  over  Lissauer's  fasciculus  -  -  ai33mm, 
366 


un,c„l,  p».„rio„.,.  Hera  thei  i,  toi.ZyT^ZV'^Z'''''T'''rV"  ■""' "'"'  "  "» 
The  defr..„,,r„ti,m  i»  met  marM  in  tho midVl  o nfT^  hjFkch„g  an  th„  •■  mi,Mlo  root  vm,." 
the  »ub,ta„,ia  Belati„o,H  of  the  two  .  d^  Ft  ttenSl  d"""  *'±'j'"'  "'  "  '"'■'  <•'"»■"  "'""■"h 
root  zone  „„aff„.t„l,  „„  lajter  .endiagTwan^r't^"'''";''^' '""  '"'"■'"'  ^'"''"'ff''  dor^l 
•he  posterior  media,,  «,„„„  „„  e,,o^Je  y^^^ZlZ  '^'V'"''  '•"S^-erat.d  areaand 
sulMtauha  fcm,..,,l„,l  tie  white  matt,  r  of  the  d^  ll  ,  ,':*''°''™''"" ''''°""''' "'™"»' '<- th» 
(rreatlydin,mish«l  in  the  liKhtomxl  an  J  iL7  "  .'^-  ^hoiigh  the  number  of  flhera  is 
;hejl«™  disappeared.  The^hteni"  ,'  d'e  foTT''™  '"  °"'-'  P"*"'  '>'''"''"''  '■-e  al 
hted  fiber,  and  to  a  corresponding  nc,S,«l  ,  ,„  j'^P'^''"''"  °'  "  '"'^'™  °'  «»  ■"«lul- 
1.  well  shown  in  Fig.  U.  """  """"^ha.    The  distribution  of  the  lesion 

Profe,«,r  H.  H.  Donaldson,  who  fou,  d  ibTT^^',   ,       'J!'  °'  ^  ^"  ""  kindly  m,«snmi  by 
•he  gray  matter  2.ISC  cm.',  Jhe  ratio  Wngl  .4  "'""'  ^■^"' ""'  '""^  "">  "ea  of 

Secliom  sfahifd  u-ith  Van  Gim     ,    '    '  ' 
eicesslveconnectiro  tissue  in  tLe  anterior  a„T^7'''""  """  "''■"'  "'''"""""  «'"-»"ne.-Tl,e 
nous,  while,  lib,o,«  tissue  stailg  ?„tL,elvt  ^dT'."""  °,"''  '"  ""  P»  ™'-  ''  «>"»»>- 
fumculns  posterior  the  ne„r,^lia  t  Len  to  1»  diff      1        '°-    '."'  """  '^'^"'^^■^  ^'-a  in  the 
re.1  color,  single  yellow  m.vel,^  sheath,  or  ..nd,'!,";:''  T™","'  "'"^  ""■■""'  "' "  ^^^^  "'  ">- 
on  „cc.ount  of  their  isolation.    There  is  a  l^nd  LvT";,    ,  "'^'  !"  "'!;'"'"'  "'"-''"^  ™'  *aT'r 
atagd„rso-m.dialwarf  from  tho  d„r  onVilsurf^^niT     "?  °' ''"I'™ '''■'••■■"«"''■  "^^ 
pos  enores.    The  blo,»l.vcss„l,  am  largerta  th,   '^,1     ,       ,        '"'""""h-  Bri.sea  o,'  the  comna 
dlsinct  fibrous  tissue  coal,  which  sW^  in  '^  fh%r''.r"''-' °' '''™  *■'"'' "■'''■•''■"'ly 
crated  in  tho  area  in  which  the  ne'Zli"  i,    „         l^''       '""  "■"■"  "'''*  """""  "■*(?«- 
however,  that  the  „„,.,  f,^.,,  „,  ,he  ^  L  Vsnff^lS' „™''  Z  "'?:     '  '>'^-'  '"»  ™P"-^on, 
liisea.s.-proce,s.  "  """  ""f""™  more  than  the  coarser  fil»rs  from  the 

™pioy^  r::v'rt  ota„;':;rfac;r':d"'""^  -■■-"■''»' '-  -""-^-  ^^  -thod, 

™ll».    The  cenlnd  canal  is  oblilLS  rp L*S ^  '","''  '°"'"""  "'"'P"*'^-'  "'  ""^ 
hforale,!  ependymal  cells.  "^        '*"'«  '"'"■''  'V  ■">  "rregular  aggregation  of  pio- 

but  the  cir,.c.t,  of  the  injm-y  c^u  ll  easitv  dTsTi     "• ".  J"'  ^'''  "'J"'-'  """'""hat  on  n-moval 
aotm.1  changes  in  the  li,.,ne,  ^  d,st,ngu,shed,  so  that  there  is  „„  doubt  as  to  Ihe 

MEAHI-KEMKNT8 

Antero-iKwtprior  diameter 

Transverse  diameter  -        -    6    mm, 

"S::ti:L:ttS^^""»  '---  ---The  s„bpi„l  .::r;„yeri,ingener.l 

'^'z:^^'^i::z^z^T''r7  ■-  "■'" '-'  ^™""-."«.  -n.e 

not  so  markcily  a,  io  the  root,  of  The  lumter  ner^    '"  '■■'"'^^'"""l  '"  'hen,,  though 


Lewellts  F.  Barker 


21 


There  are  no  degenerattxl  areiw  risible  in  the  funiculi  nnteriores. 

The  funirali  Inti-rnl™  prem-nt  mnrlied  alteraliona.  On  each  side  the  direel  cerclwllar  tract 
of  Flechwi-  ia  almost  complotoly  dcfjenerated.  Only  here  and  there  can  a  tilir  of  largo  cnliljer 
ho  made  out  in  the  area  corresponding  to  this  fasiiculu«.  A  good  many  line  filjen,  are  tisililo 
in  thai  portion  of  tho  area  immediately  adjacent  to  the  main  part  of  the  piTamidal  tract,  but 
tho»o  are  doubtless  themselves  filers  of  tho  pyramidal  tract  Bliich  are  norn'ially  miswl  in  with 
the  filxTS  of  the  dirwt  cerebellar  tract.  This  marked  area  of  degeneration  of  the  dinrt  certW- 
lar  tract  is  siluatwl  as  always  in  tho  dorao-lateral  portion  of  the  funiculus.  The  viiitro-lateral 
region  of  the  funiculus  shows  no  distinct  area  of  lightening,  though  the  largo  flliers  of  that 
region  seem  to  \nt  loss  numerous  than  normal.  It  is  therefoto  proljablo  that  the  ventro-luleral 
coreliellar  tract  of  Cowers  has  suffered  some,  though  the  chief  lesion  in  tho  funicidi  lateralea  is 
undoubtidly  an  esteusive  degeneration  of  tho  dorso-lateral  direct  i-ercbellnr  Ir.ict  of  Flechsig. 

Tho  pyramidal  tract  is  not  degenerated,  nor  can  I  make  out  nnv  alteniliou  in  tho  fasci- 
culus lateralis  proprius. 

In  the  funiculi  ijosteriotes  there  are  some  partial  degenerations  t<ilerably  defmitely  local- 
izable.  Tho  partial  degeneration  assumes  approximately  the  shapi-  of  tho  letter  W.  The 
lateral  limbs  of  the  W  correspond  to  regions  in  the  funiculi  cuneati  of  the  two  sides;  the  medial 
Imibs,  to  the  regions  in  the  fasciculi  graciles  of  the  two  sides.  The  degeneration  is  fairly  sym- 
metrical. That  in  the  fasciculus  cuneatus  of  each  side  occupies  a  rather  broad  atrip  corr»ipond- 
lug  to  aliout  one-thiitl  of  tho  width  of  the  fasciculus  at  its  broadest  part  (opposite  tho  substantia 
gelalinosa).  Dorsalward  the  strip  becomes  narrower  and  cea.ses  at  some  little  distance  from  tho 
dorsal  pi-riphery.  Venlralward  tho  degeneratixl  area  in  the  rascicuhia  cuneatus  approaches  the 
me<lian  lino  and  fuses  with  that  of  tho  fasciculus  gracilis.  Though  this  degeneration  passes  far 
ventralward,  almost  to  the  substantia  grisea,  it  does  not  quite  reach  the  latter.  Flechsig's  ven- 
tral root  zone  remains  almost  entirely  undegenerated.  A  strip  of  aomo  breadth  intervenes 
lateralward  from  tho  degenerated  area  l»>tweeQ  it  and  tho  substantia  grisea  of  the  dorsid  horn. 
In  the  fa,sciculua  gracilis  the  degenerated  atrip  is  narrow;  rather  fusiform,  and  more 
medially  than  laterally  situated.  The  atrip  is  widest  and  tho  degeneration  in  it  most  intense 
about  midway  U'twwn  tho  dorsal  periphery  and  the  ventral  estremitv  of  tho  fa.sciculus.  The 
degenerated  area  does  not  extend  dorsalward  as  far  as  the  posterior  surface,  but  growing  grailu- 
ally  less  distinct,  ti'rminates  at  some  distance  from  this.  Ventralward  tho  strip  fuses  laterally 
on  each  side  with  the  degenerated  atrip  in  the  fasciculus  cuneatus. 

It  will  be  noticed  that  the  description  of  this  degeneration  corresponds  very  closely  in  a 
negative  way  to  Trepinski's  description  in  a  positive  way  of  his  third  foetal  system  In  th.>  thoracic 
portion  of  the  cord.  (Cf.  Fig.  290,  p.  m,  of  my  lx>ok  on  TAe  AVitom  SyMem.)  It  also  reminds 
one  forcibly  of  Fli'chsig's  description  of  tho  degeneration  in  a  case  of  lueipieut  tal»>s  in  the 
upper  portion  of  the  thoracic  cord,  described  by  him  in  the  XitumUtgischea  Crntralblall  for  1890. 
Lissauer's  fascicidi  are  intact  on  both  aides. 

Thi'so  specimens  reveal  further  im|X)rtant  alterations  in  the  white  Uliera  which  enter  the 
gray  matter  of  the  cord.  Thus,  while  Waldeyer's  nucleua  of  the  dor.sal  horn  still  slnius  black 
aud  is  rich  in  fine  medullalod  libers,  the  nucleus  dorsalia  on  each  aide  is  almost  entirely  devoid 
of  them.  Tliere  is  a  marked  contrast  betwren  the  nucleus  dorsalU  of  this  case  and  that  of  tho 
case  to  be  sulm^uently  doscrilied,  where  many  of  the  fine  medullated  fibers  of  Clarke  nucleua 
are  still  relainwl.  The  Bubatantia  gelatinosa  is  still  crossed  with  many  radiating  bauds  of  fine 
black  fillers,  and  medullated  fibers  pass  forward  towanl  the  anterior  horns  of  gray  matter. 

Sirtloiiit  slaiiird  trilh  fun  (litnon'a  melhud  and  nith  Schmam's  vramiim  carmine.— 
Siiecuiions  ataiuMl  by  these  methods  demonstrate  very  beautifully  tho  pmliferation  of  tho  nou- 
rogha  in  the  areuaof  partial  degeneration  in  the  dorsal  funicidi.     In  the  place  of  tho  fibers  which 


. ^M.ABx    ATAXIA 

too,  a,  m  the  pnr,  lumhali,,  there  " "  ™d™o    ,    .T""'  """  '"  """  f"*™"™  frraoili.     Hen 

Pass  cebvicaus  (iNTUMEscExm)  (Fig.  42): 

DiMEitgioira 
Antero-poBterior  diameter        . 
Transverse  diameter    -  '       "       "       "    8-Smm. 

dec.a»e  of  "hite'Xr'^fTetrrJr  ""'',r''*^^*"'''«''' ""•"■■"-» -™.-- -The 
-.ble^    Therearefewerner.ecelUta.h™!;"^"'"^;"  ""■  '"'"'^  """'riore, ™ dWiif, 


Lewellyr  F.  Basiek 


23 


Is  endenl  macroscopically.  The  length  ot  the  poii»  in  the  ventral  middle  line  i,  2.2  en.,  tran,- 
ver!«)  distance  bet»e..n  nervi  trigemini  of  l»o  side,  8cm.,  maximal  thickn™»  2.6cm.  The 
depro.,ion  between  the  pyramis  and  the  oliva  i»  more  marM  than  usual.  The  lower  part  of  the 
medulla  hn«  b.,,n  InjunHl  on  iKmoval  of  the  brain,  .so  that  the  nucleus  funiculi  cmeati  and  the 
nucleus  funicuhgracUw  cannot  to  examiu«l  ccept  in  their  up,K.r  parts;  ther.',  however,  they 
are  smaller  than  nonnal ,  the  bulk  of  the  uppi-r  part  ot  the  nuclei  funiculi  cuneati  is  cTlainly 
d.mm„hed.  There  ,s  slight  thinning  of  fib..r,  in  the  stratum  interolivare  lemnisci  and  also 
higher  up  m  the  lemniscus  mclialis.  The  pyramids  are  well  developed  and  stain  noriually. 
The  nuclei  arcuatl  are  small.  The  layer  of  gray  mailer  of  the  nucleus  olivaris  inferior  looks 
hmnor  than  normal  and  the  numterotcell,  present  in  it  somewhat  reduced.  The  fibrie  olivoK.-,.re- 
belare,  are  leas  prominent  than  normal,  as  are  also  the  fibne  arcuate,  Mlernw.  The  conms 
ri-sliformo  IS  rather  smaller  than  normal,  and  shows  a  thinning  of  fil».rs  with  nelwork-lik- 
increase  of  neuroglia.  The  nuclei  nervi  hypoglossi  are  sm.lller  than  normal,  and  conlaiu 
correspondingly  fewer  cells.  Tbo  nucleus  on  one  side  c-outains  fewer  cells  than  that  on  the 
other  The  Inictu,  solitarii  are  present,  and  show  no  recognizable  alterations.  The  tnictus 
spinalis  nervi  trigemiai  l™ks  normal.  The  lateral  region  of  the  formiitio  reticularis  and  the 
nuclei  lalerales  are  much  less  develope<l  than  in  normal  specimens,  and  the  notch  dorsal  to  the 
ohve  IS  deepened  .is  in  Menzel's  case.  The  mi«s  of  substantia  gelatinosa  medial  to  the  tractus 
spinalis  neni  tngomlni  is  small. 

In  the  pons  the  diminution  in  size  is  general,  but  the  various  structures  appear  to  be  fairly 
evenly  developiKl  m  relation  to  one  another.  The  fasciculi  longiludinales  ponlis  and  flbrm 
transverste  pontis  look  normal  and  the  great  nuclei  pontis  are  n-latively  well  represented.  The 
masses  of  gray  matter  in  the  para  dorsalis  pontis  are  not  markedly  altered  in  appearance. 

THE    CEREBELLUH 
1.   SaoitTAL   SECTION   lU   MtDlAN   PLANE  (Fig.  25)  1 

a)  The  arbor  vital. 

(1)  Main  vertiral  iimft.-This  mirfullary  stem  receives  a,  usual  the  bands  of  meduUaled 
fibers  (lammmmedullarea)  from  the  first  three  Wande  ot  the  monticulus  and  part  of  those 
from  the  fourth  IPond.  Pari  ot  the  fllx,r  <Kinds  enter  the  main  vertical  limb  from  in  front, 
part  from  behind.  The  miun  vertical  limb  descends  to  form  with  the  horizontal  limb  the  fiber- 
mass  of  btilhng  8  corpus  trapezoideum. 

(2)  Horizontal  limb.-Tbh  medullary  stem  receives  as  usual  the  vertical  lamina)  me<lul- 
lares,  corresponding  to  Stilling',  fifth  and  sixth  Wd,ule  and  most  of  the  white  Blien,  from  Still- 
ing s  fourth  na„d.  It  runs  forward  to  enter  the  corpus  trapezoidemn  from  behind.  Below  it 
receives  the  Martaste  from  tuber,  pyramis  oud  uvula. 

(S)Stilliy-s  corpxu,  trapezoiieum.-\n  the  median  plane  this  is  of  minimum  dimensions 
Its  conhgurallon  and  contents,  however,  correspond  to  StiUing's  di-scriptions  of  the  normal 
cerebellum.  It  receives  directly  or  indirectly  the  laminai  medullares  from  all  the  subdivisions 
of  the  vermis  superior  and  inferior. 

1  .. . ''}  'I''!  O""' "'"''""'■  *c.w«a(|-on-com»ii»»ure.-This  includes  the  fibers  passing  from  the 
eft  lateral  half  ot  the  vermis  into  the  right  half  and  rice  ifrsa  at  the  base  of  the  lingula  and  ot 
the  lobtUua  centralis,  and  throughout  the  whole  extent  ot  the  main  vertical  limb  ot  the  arbcr 
vitae.    it  IS  Stilling  s  '^grosae  vordere  Kreuzunga-Commissur." 

c)  Tlie  posterior  decuaaation-commitBure.-Tba  includes  th-j  fibers  which  run  Irana- 
yersely  from  one  side  of  the  wonn  to  the  other  at  the  posterior  end  of  the  horizontal  limb  ot 
the  arbor  vitie,  immediately  after  entrance  of  the  MarMate  of  the  declive,  folium ,  and  tuber 

d)  Tlie  niKleua  of  llie  roof  (nucleua  faaligii).-riua  nucleus,  StiUing's  Ivchken,  is  in 


24    Desob 


'^^^^^-^^^^^^^^^^lllll^lll^^^j^l^^  AT.,U 


mnrg,,,  of  the  „„cl„„,  Jentalu,  and  the  ta^rnj""""  "■'''^■''  '»  '"""W  betweef  hj  „^  '° 

meduUarea  of  the  other  oortion.  „#  .k    ■  ,    ""^oM  and  al„ina  normally  ■,.  ,1„  ,i    V     • 

BESORIPrxO.  o.  THE  Z^s,  .„,,.VCKO  CASE  .CASE  XX, 

GEBEBBUU 

HEMiaPH^aiL-M   DEITBUM 

orbit^n,  ofX  ^  du:'STZ'ZrjZr"'  ""°  '"=  ■°''""-'  -a-f  Of  the  par. 
tranaverau,  by  a  distance  of  0.5  cm       '  ^  '^''  '""«™'-l^  "»  'ar  a,  the  aul cuVor?  ,.1" 

370 


IiEWELlIR  F.   BaIIEB 


26 


FiMUra  proprio.— The  angle  formed  with  Ihe  longoal  anlempooterior  diameter  is  l.T. 
The  linear  di«tance  from  the  junction  with  the  ramu»  anterior  horizontalia  to  the  juiietion  with 
the  ramus  postarior  aaccndens  is  «.2  em.  The  ramua  posterior  aacendi-ns  ki»'»  off  at  an  angle 
of  71-  and  is  2.0  cm.  in  length.    The  ramus  posterior  descendens  is  I  cm.  in  length. 

Ramiu  anhrior  hoHionlalu  and  raiaiu  antvnor  aHcemlem,  -  These  arise  by  a  common 
Item,  the  horizontal  ramus  cutting  deep  into  the  gyriLs  frontalis  inferior  and  n-achiutf  to  within 
0.7  cm.  of  the  sulciw  frontalis  interior.  It  is  verj  prominent  on  the  lateral  surface  of  the  cero- 
bmm.  The  ascending  anterior  ramus  is  only  0.5  cm.  long.  It  pass™  upward  ami  IwckwaM 
from  the  common  stem.  II  is  inconspicuous  on  the  lateral  surface,  espt^ially  in  comparison 
with  the  sulcus  diagonalis  operculi. 

Sixers  CEMTBALis  [RoLism].  The  medial  extremity  extends  beyond  Ihe  junction  of  the 
convex  and  medial  siu^aces  of  the  hemisphere,  enctxsichiug  for  a  (ew  millimeters  upon  the 
medial  surface.  The  genu  superior  is  more  marked  than  the  genu  inferior.  The  sulcus  turns 
backward  mto  the  paracentral  lobule  nud  stands  in  the  typical  relation  to  the  extremity  of  the 
sulcus  cinguli  (r/.  Elierstaller).  Ihe  lateral  extremity  of  the  sulcus  is  Bituat<-,l  l.r.  cm  from 
the  fissure  of  Sylrius.  Between  it  and  the  Sssurc  of  Sylrius  is  intercalatwl  an  oblique  sulcus 
(the  course  of  which  is  almost  perpendicular  to  that  of  the  lower  third  of  the  sulcus  centralis) 
It  IS  2.3  cm.  in  length  and  is  bifurcatwi  at  its  lower  extremity.  This  is  evidently  a  »ijecial  case 
of  Eberstaller's  clr.-Furclle  (Betzius's  "sulcus  subcentralis  anterior  "). 

No  anastomoses  with  other  sulci. 

Relative  length 7.8  cm. 

Alisolute  length 10,o  cm. 

Inclination  of  sulcus  with  fiasura  lougitndinalia  cerebri,  measured  on  a  line  drawn  from  Ihe 
point  where  the  sulcus  cuts  the  medial  maif-in  to  the  lower  extremity  of  the  sulcus,  66  . 

LIVRAR  DlsTAHCE  OP  THE  HEDUL  END  I 

Krijtii  the  frontal  pole  - 
From  the  occipital  pole  ■       -  - 

that  is,  as  56:44. 

LIKEAR  DISTANCE  OF  LATERAL  END 

Prom  frontal  polo 89  mm. 

From  occipital  pole      -       -  -  112  mm. 

SCLCCS   PKJKENTRALI.S: 

1.  Par«  in/mur  (micm,  ptvcmtralis  inf.rior  of  Ebe.rataUer).~Th«  pars  inferior  is 
superacially  continuous  with  the  pars  superior,  though  the  two  segments  are  distinctly  sepa- 
rated from  oueanother  by  agyrus  in  the  depth.  The  lower  extremity  of  the  para  inferior  reaches 
to  within  0.9  cm.  of  the  margin  of  the  Sylvian  fissure,  making  a  dwp  incisure  in  tlu.  interval 
Ixtn-ecn  the  sulcus  subcentralis  anterior  and  the  sulcus  diagonalis.  The  pars  inferior  about  its 
middle  forms  a  deep  anastomosis  with  the  posterior  extremity  of  the  sulcus  frontalis  inferior. 
At  hrst  Bight  there  would  seem  to  bo  no  ramus  anterior  of  Elierstaller  (ramus  horizontalis  of  Cun- 
ningham) on  this  aide,  „ut  on  closer  examination  p  .d  comparison  with  the  onpoaite  hemisphere 
It  la  aeen  thi,t  In  reality  auch  a  ramus  exists.  It  is,  however,  completely  a'epariited  from  the 
mam  aulcas  by  an  annectant  gyrus  extending  between  the  lateral  and  medial  roots  of  the  gvrua 
frontalis  medius. 

2.  Pars  sujienoi-  («iijci<.<  pntcenlralis  eujxrior  of  £(«r«(nHer).— This  pan,  is  a  trans- 
TCially  placed  footpieco  to  the  sulcus  frontalis  superior  with  which  it  forms  a  deep  anasto- 
mosis Its  lateral  extremity  extends  backward  into  the  gyrus  centralis  ani.rior,  posterior  from  'ho 
medial  extremity  of  the  pars  inferior  and  reaches  w-ilhin  0.5  cm.  of  the  sulcus  centralis.    The 

371 


'  THE  SULCUS 

120  mm. 
96  mm. 


tor,.„.h  the  ,„„|i„I  b„r,I..r  of  the  "mtphl  .JT  '.?'  "■"  P»" '"I».rior  fall,  (bjO.r.cm" 
mo.U  then,  of  „  .„,„„  „,,,,^  ,,  pr,,l.,;TX"idiS"T  •"■•.?  ,"''  '"  ""  "">■  "">'«  d.™lop. 

«-p«raM  t™  ,he  m.^i„|  e.tLily  „r  LVSm' J     T"?,'  >«*""'- »■"'  1"™1  mn,;.  i, 
only  0.4  „™,  in  thk.k„w,,    p,„.i      1,„A  vard  fram  .rr.K  ™"",  ""■■""""•  ''^  "  "»™''  ^^1* 

l.r>  cm.  I,  a  ,vell-,iinrk,-d  brancl.  (ramii,  ,^M'ii        .   ?^   «'nlruli»  anlerior  for  a  distance  of 

-dcu.,  ,„„ead  „f ,,,  „  part  of  ,he  »uie^  pn^J,^^  ''^1°  '"'  r**"""^  ""  "  '""■'  "'  "'"  '""<" 

pne>^„tn,ii.,  „„K.ri„r  a„d  ,he  „,lc™  fmS^^irfl''."'"'™'"-"'""'" '""""' ',y  the. „le„, 

crucjfonn  tvpe  "  .hfch  t„,  frc„e„«^^„"  j^^S    "  '"'  ■""■-"y  *--«'  example  of  the 

«^^.«.if  ™r  i:;'„s■;rs^'::^^^x;:^-^  co„.e„ce,  „„ 
^-t;:5e:^i;'S^-;--;S°:^^^ 

bitureate,  ou  the  n„^ial  mawn  of  the  hemf.„h  "^'"'"^  '"■•  »  dWance  of  I.4cm.,  .here  il 
0..e  of  ,he„  „,„.,  f„„,„j  „I™^°LXr',;" '°. '°™  ")■<>  »«5''".v  curved  t.™inai  fZ^' 
ht™,lw„rd  for  the  «„me  distant,  ,o  te™ina  e  in  Z^t  ?  t'"™'"  "'  ''  ™''  "»  <>""S^. 

""ir:rrt:;!rr''i'^"^^  '"''"""'"" '"'"'" 
j^».  .jn.s  0.,  cm.  b™.d::rh"--'it"vr.Tat*:i^^^^^  --^ » -'»'«*'  «-- 

^Ith  the  gjn,,  f„„,„|i,  ^^^.^  grn«  erident]?"  ',''°  ^^"''  '">"'"''"  '-"'"or 

Tnfrn,n,ulu„g.  The!x»teHorp„rlofthe^cnr.„,ltL  r.  '"  ^l^^talW,  ^Mer, 
he  gyrus  prapcenlndis,  extends,  lorlnnn.;,  u  "„  forX  °  ^  ^  "^'f  "''"■  """  <»"  ''"'"ior  of 
.les  m  a  transversal  snlou,  which  cuts  a  «v ,  M„  Z"'"  I  '"7,"'""  '•""n.lwarf.andlermin- 
the  sulcus  frontali,  ^,^^  „„,,  ^  J  the  «.«  tSZ,     ^^"  "r"""*  •" "■'"■'-  ''■^■•"■■of 

antenor  hori«,„t„Ii,  „t  the  Sj-lvian  (!.„,  J  ^     '"»-?uh.ns  to  »«hin  O.Scm.  of  the  ramus 

dir^ted  rrh:L'nr  a^vt::;:?  ™5^tlt'":r;rtn""  r  °''''''- '■"' " 

the  gym.,  franlalis  medins.  From  a  WtiL  a  „v„T  '"y^"")  "P™"!  and  mclialwarf  into 
cus  run,  forward  for  a  distance  of  cm  "^riw',:^!' "i '''r'''''''''' ■>'«*'  the  main  ™^ 
into  the  gyrus  frontalis  medius:  it  then  h™,  1  ^  ^™ ,°'  "  '■""*  ""li"'  """U'  "hich  cut, 
middle  of  a  sagittally  placed  ler^il:  :u,^^*■*''f„*^i7'  Z^ '°"'"""'«''  ^  ""  '-'t 
exactly  on  the  boMer  of  the  orbital  surfa™  tI  ,  "*''•  ^''»  '^""  ''  ^"""W  almost 
Mem.  in  f^nt  of  the  lateral  extrem  ,"'7;^^  ,^;„:'^™' "'^^^  ,"■«  termin,d  pieced' 

that  we  have  here  to  deal  with  a  fusion  of  al  '"  ■""««»«»■    It  seems  probable 

with  l^he  sulcus  radiatus  of  taUer       "'°""«"°'  '"•"i"-  ■>'  "■=  "ulcus  fro„.alis'^taferi„: 

sulcus  p^;sr^-i:;:j3;;;^^^7-'°m«,^ 

n.»l,al  margin  of  the  hemisphere.  TheTulcr  ,  IT  !!.\'^'"'  2™.  distant  fmm  the 
anlerior.  I  ,^„i,i  Eb,^,P  .^.^  thaUhis  p„  w""  n  ,  ^^  '"'o  "">  ^^™  """■^i» 
postenor  of  the  sulcus  pr.-ecentrali,)  bolon^T™?!    .    If  "'^,  '^^  '*"^''"  "">  ^mus  aagiltalia 

The  main  sulcus  follow,  a  tortuou^^lw  ^  '"J"""  ""''''"  '"•■"»"»  ^-Peri"'- 
f^nt  about  2.5cm.  from  the  margin  ^fT  h":rphr1."at„Tt' ,™1-  "■^':"™™'-'  '" 

'  ™.  ™..  .„  „„_. .  „,„.  „,„„,„,,_  ^  J^  ■"»"'  tte  junciron  of  ,ts  posterior 

372 


Lewellvh  F.  Barker 


27 


and  middle  thirds  It  given  off  a  rnmuii  which  cuts  lalernlivnrd  iind  aliKhll;  Imckminl  d.i'p  luto 
tho  ([Tni»  fnintnlls  mediun.  Bt'twiwn  thin  rnmm  and  the  milcim  crulnilla  In  an  Isalnted  gynw 
which,  at  first  siffht,  mljfht  be  thoiiffht  to  belong  to  the  gynw  frontiilln  Hitperiiir,)>iit  whk-h  iniut 
lie  n-gardcd  as  a  part  of  the  medial  portion  of  the  Kjnw  fiontiilii*  niedliiti,  Tlie  wilcnn  fronta- 
lis superior  is  nowhere  Interrupted  by  itnneetnnt  gyri,  nor  does  It  form  anostuuiones  other  than 
that  with  the  sulcus  ptTrcentralls. 

SuLCi-s  raosTALis  iiEDius.— This  is  a  pronounced  sagittal  sulcus,  nlmo^t  completely  divid- 
ing the  gyrus  frontalis  medius  Into  two  halves,  and  so  estallisbing  the  "four-c-onvolittions" 
type  of  the  frontal  lobe  in  this  hemisphere.  It  lieglna  behind  close  to  tho  inferior  jiortion  of 
the  sulcus  priecentnilis,  ns  a  shallow  piece  which  may,  in  reality,  rt-present  a  detacheti  ramus 
aniorior  of  tho  inferior  prn<c<mtral  sulcus.  One  nud  llve-lenlhs  em.  in  front  of  it,,  posterior 
eitremlty  it  is  crossed  by  a  transversal  sulcus  1.5  era.  lonff;  then  liecoming  .ery  dii-p,  it  onlends 
1 .6  cm.  f.lrther  forward  and  bifutt?a(efl  Into  a  me<Ilal  mnins  1  cm.  long  and  a  latenil  (more  sagit- 
tal) ramus  which  oitends  for  a  distance  of  2cm.  and  Is  then  intemiptisl  in  the  ilepthlivan 
annectnnt  gyrus  connecting  tho  pars  niedialis  with  the  pirs  lateralis  of  the  gyrus  frontalis 
medius.  In  front  of  this  gyrus  in  the  depth,  the  sulcus  makin  a  dw-p  cut  IsickwaHl  and 
medialward  Inlo  the  pars  lateralis  of  tho  gyrus  frontalis  medius,  while  farther  onwanl  it  bifur- 
cates to  form  the  two  limbs  of  the  sulcus  frontomarglualis  of  Wernicke. 

ScLcrs  ciNOCLi.— This  sulcus  lielongs  to  Eberstaller's  "continuous  type." 

The  pars  anterior  begins  under  the  front  part  of  the  genu  corporis  callosi.  passis  lorwaid, 
then  upward,  and  later  backward.  It  Is  very  shallow  in  all  parts  of  Its  course  and  runs  unusually 
close  to  the  corpus  callosum,  making  a  very  narrow  gyms  fornicatus  In  front.  At  its  |«;sterior 
extremity  It  curves  up  into  the  medial  surface  of  the  gyras  frontalis  superior,  to  terminate  0.7  cm. 
from  the  margin  of  the  hemisphere. 

Tho  main  course  of  the  para  anterior  is,  however, continued  biickwnrtl  as  the  pars  Inter- 
medius,  the  latter  being  much  more  widely  separated  from  the  corpus  callosum  than  is  llie  iiars 
anterior.  Behind,  the  pars  intemredius  liecomes  somewhat  irregular  and  goes  over  into  tho  jjars 
jiosterior.  The  ascending  pf)rtion  of  tho  latter  undergoes  a  Y  shaped  bifurcation  {tiUfiuaiiig 
f/egabell).  The  anterior  limb  of  the  Y  passes  up  to  the  mislial  margin  of  the  hemisphere  and 
lerniinates  n  few  millinieters  behind  the  metlial  extremity  of  tho  sulcus  centralis.  The  iK>sterior 
li:nb  of  the  Y  terminates  in  the  pra-ceneus  without  reaching  the  margin  of  the  hemisphere. 

ScLCL-s  OLrACTORlus.—  Deep;  begins  1  cm.  from  the  medial  margin,  be-hiud.  Bifurcates  at 
posterior  extnmity.  No  anastomows.  Length,  4.1  cm.  Passes  forward  and  medialward. 
Reaches  medial  margin  and  extenda  0.7  cm.  ui«n  medial  siu-face. 

Sc[,ci-a  onatTALis.— This  Is  of  the  H  tyjw. 

The  sulcus  orbitaUs  Irmsversus,  ramus  bleralis,  ramus  miilialis,  and  ramus  inlermedius 
are  all  present.  The  ramus  intormodius  forms  a  superficial  anjislomosis  with  the  ranms  laleni- 
lis.  Running  backward  from  the  sulcus  orintaUs  transversus  into  the  gyms  f.ontalis  inferior  is 
a  sagittal  ramus.  Its  course  Is  nearly  parallel  to  that  of  the  medial  extremity  of  the  sulcus 
orbltalis  transversus. 

AccKssoay  sulci  of  tub  toavs  frontalis: 

1.  Sulcm  diagonalia  opei-cuii.— Very dcepi  typical  direction;  extends  2.4cm,  on  lateral 
surface  and  1  cm.  on  inferior  surface  of  para  opercularia.    \o  anastomoses. 

2.  Sitlciis  rat/m/»s.— Cannot  be  dLstiuctly  made  out.  If  present  at  all,  it  belongs  to  the 
Bulcus-complex,  composed  of  that  part  of  the  sulcus  frontalis  inferior  which  lies  along  the  fiont 
part  of  the  base  of  the  pars  triangularis  and  anastomoses  farther  forward  with  the  lateral  seg- 
ment of  the  sulcus  frontomarginalla  of  Wernicke. 

3.  Sulcus /rontomarginatia  of  Wernicke.— The  lateral  portion  (//»,)  anastomoses  with 

373 


28 


J^!!f^-- ._:^B^^n^^^^^S^^  ^^^^_^ 


olth,  .„k„.  fr„,„„ll.  „„„„,,  ,„„  „,„  J^'J"'™  '  ""' °'  ''•'"rn.tlon  „f  the  ,„t,.ri„r  p,,™!,*' 

Tho^yn,,  t,„„.ali,  .„p..ri„r  i,  .|ivi,,„l  iJi'ZTAn'^^y'"''^"''''''''''"!'"'''- 
l7'""-""'«"««(n.«li„l  f~nt„I.„lJ    ',c,„„'r„ll'"r'  ">''  ''^  ■«,  «""'l.-lop,i  .ufc,„ 

tan»n.r,u«„„,lj„i,o,.i  *   /•    "  '»(rl"«    °  "■"  Wr  part  o(  the  .ulcu,  n»trall, 

.-..  fn,„.„n.  .,.p,.ri„,  al a  pou.wSv'^wl^r.'ri'''"  ","""  ""'™"' "™""'"'-  '»   "« 

bt...   furcheiiretehcn  Oehinii.,,."  """'  "'"  ""■>  "'"■ »»  "Wiuaunleii  »i„,|„„g,_ 

1.  ^SulciiH jmHtcfntralin  ~Thi»  .„i„„_  : 

c..»  interparirfali,  p^prfu,.    j,,  I„,e™l ,  "J  ""I;;''"''"""  °°"  """'  ""'  """tomo*,  with  the  ,u|. 

2.  S,.fc,„  inlerparielali,  pm,Ju.^nT^"',  ^'"^  ""  ""'«'»°'  K.vri  i"  the  depth. 
Wera  pcterior  limb  of  the  x/wh  oh"ut,  aol^u"  JC  ""  '"''T'^  »"l«.»complei.  The 
«.t  nf  the  eomplc,  by  an  annectanl  J^,  i° "^e  i„.."'^^""'''"'i"''''  "  ""I™"""!  »«>".  the 
oom.«pond,  t„  the  „ai„  co,u«,  „,  ihfJI^  Lpl.C  .h    ?  .""f' "^  «^'<'"°^  """> "'  "o  « 

he  lobul,,,  parietal,,  inferior.  The  medtaUatTSSnf  ^K  "'"'  ™"'"  ""P-™  h"" 
lateral  l.r,cm.  The  medial  poaterior  limb  ZTi  >''"'''' '  •"»  2 cm- in  leugth.  the 
™rd  for  2cm.,  „he„  i.  biCate^  S^^lX,  "imW  r.'"':"''"' "■'''  ■"«''"^  "^iS 
paneta  ,,  anperior,  the  other  limb  communiraHn^^n-rii  ^""'■™'""'  ™"  '"'"  »'e  lobulua 
aulc„,m^,janetali.(the„.canedparc«rpi;:r::fe3tS."''^  the  p».erior  part  of  the 

a.  iiifcus  jjfiroiTcijiiVofis  of  Wilder      Tt;        ™"'  """OT)' 
of  .hefad«c„„v„.„.    ^^anteiritre^^^ir^^^^^^  """""^  P»™'<>-Hpitali, 

0.7   m.,n  front  of  the  fl,.„ra  parietoaceipLu      1,^,1,    .""  ""'  """*"<"  "'e  hemi.phere, 

^.  ■»  °' 'he  hemisphere  where  it  app..aX.n;.„mLri^.T''''r''^  "  '•'"'■"■  '™'  '"" 
but  u.  examination  it  i»  fou^id  to  be Tpamtod TromThJ?  '"  '"''"'  ""pitalis  transversu,, 
almo«t  to  the  a,  rface.  '^"'"'  '"""  "  ^^  «°  ""terrupting  gjru,  which  leache, 

OI'LCL'S  PAR      r.iLIS  SCPEBIOB  ■ Thn        1 

anlcuapr«H,uneiuponthefacie,conve,a.  Tftoa'^te„T„Mr'  "["""'^'"n'taualionof  the 
lcm.W.    Ildoeanotana.lomo^withthe.ncurr^t^",',-""'^™'';"'"™^ 

f™"'  s™P,„„,ua  ,.,„  ,,„„,  PaJ»r-!?h^;'™r/''''''''''^^'''«'^i°'«T»'rieWi,. 
".th  the  pa„  posterior  of  the  a,Ucu.  cinguli  Z«,b^,J"T,^"™' ° '"'•*''*"'''  »n««'omo.i, 
P»tenora„d  an  inferior  tertnim.!  ntmua  A^tZS  ^f '"' ^''•■"- ■'"'  bift.rcate,  into  a 
Bulcua  pnecunei.  ^  ""'"  ^"bmd  ita  middle  it  anastomoaja  with  the 


Lbwellyh  F.  Babikm 


29 


FiMi'RA  PAiiiETOoc('iPiT>  *.  Dinlance  from  tuMlinl  mnrffin  of  bmilxpht>n>  t<>  point  of 
junction  with  the  tniiiciu  of  the  ctttcuriui)  llnMiire,  S-Kcm.  Tbe  flnoum  oxttmilii  l.riciii.OQ  tbe 
fackw  conrcxa  and  th(>n  blfiircatii  Into  two  ohort  nupirrflrial  terminal  rnini.  Ou  o|N'nluK  up  the 
flitHure  from  the  mwliiil  nurfact),  the  fiu|M'rficitfi  poMtt-rior  lo>>i  pitrii'tuliii  conirn  Into  vit>w.  A 
t;pii!al  gymn  cunvl  uf  Eeker  exiHtn.  Nmr  the  medial  txmlfrof  the  nurfoce  u  det'p  tortuouH 
Hulciu  piixwH  upwiird  and  about  Irm.  from  the  nMHlial  amiK'n  of  the  heminphcre  n-achos  the 
facli'H  miwliftllK;  It  then  tiirni*  piit(fltliil]j  forwimt  throiiffb  the  prni-iim-ufi  for  a  iliHtnnco  of  ;2i-i)), 
and  tbun  tumii  vprticallj  upwanl  1cm.  Iwbind  tho  kuIcuh  pru'cunci  to  termioate  nt'iir  th«>  nuHlial 
margin  of  tbe  h<>miHpbi-n<. 

Tb<4  IKtrtlon  of  the  nuperHcli-ii  poNterior  Inttirnl  fmm  the  tiulcmi  junt  dewrilMHl  U  ninrked 
near  the  bottom  of  the  fiiwura  pnrictonccipitnlis  by  n  trannvcrse  Hulctu  atxivu  wbtch  in  a 
V-shnpod  mili'Ufl.  Tbe  hittnal  limb  of  thifi  V  correKpondt  to  the  anterior  liml»  of  Wfurtation  of 
thf-  flsnura  imriiitooct-ipitaliM  an  necn  from  tbe  facies  convexa.  There  Ibui  ari»(ii  a  diminutive 
lubuluH  purietoocripitaliN  in  the  nenHe  of  Relziufi  at  the  lower  end  of  the  fissure.  It  come*) 
honertT,  in  the  domain  uf  the  ^ynis  arcuatun  ]>OHterior  of  the  lobuluii  itiirietaliH. 

FinnrRA  caU'arina. —  I^'n^'th  of  tnmciin,  l.Hcm.  The  flsHure  extendH  S.Hcm.  I>e5nnd  the 
truncuM,  termlnatinff  Ix-bind  O.I)cm.  from  the  margin  of  the  bemiaphere,  where  it  undurgoefl 
a  slight  bifurcation. 

Scuts  oivipitalis  THANnvERsri.— It  beginn  0.5  cm.  liehind  the  fifMura  parletooccipitalio 
and  Irm.  from  the  mt.-<tiul  margin  of  the  bcmi»pbere.  Its  latt^nd  extremity  anaHtomonen  with 
llie  Hulciu  occipitaliH  lattiralis,  giving  riito  to  a  stellate  sulcus-couiplex  at  the  junction  of  the 
occipital  and  temporal  lobua. 

Sulci  occipitales  Bi'PEBioRES.—There  is  only  ono  such  huIcum.  It  in  situatwl  iH-biud  tbe 
nulcus  occipitalis  tranxverHUs.  Slightly  curvet),  it  nms  panUlel  to  it  from  t>e]ow  upward  to  the 
niiirRinof  the  htimiHpbere.and  then  turuH  and  nmson  themetlial  nurfacuof  the  lubus  occipitalist 
delimiting  a  |H>ripheral  gyniH  of  the  cuneun.  Parallel  to  it,  and  separating  the  apical  from  the 
middle  part  of  the  cuneu«  on  the  medial  surface,  iti  a  second  short  sulcus. 

Si-Lfi  (xciPiTALES  LATEPALES.— Opposito  the  polus  Occipitalis  and  nmning  parallel  to  the 
mArgin  of  the  hemisphere  at  a  distance  of  I  cm.  from  it,  is  a  sulcus  3cm.  long.  Only  the  mf>4lial 
one-fourth  of  this  is  aliore  the  level  of  the  flssura  ctilcarina  of  the  medial  surface.  Tbe  rest  is 
opposite  tbe  gyrus  lingualis.  Anastomosing  with  this  sulcus  near  its  upper  (medial)  extremity 
is  a  sulcus  S^cm.  long.  At  the  jimction  of  its  medial  and  anterior  thirds  it  forms  a  superficial 
anestomosis  nith  the  sulcus  occipitalis  transversus,  though  a  det>p  occipito-parictal  anuectant 
gyrus  prevents  fusioa  in  tbe  depth. 

Sulci  tejiporales  tbanstebsi.— The  sulcus  temporalis  trnnsvers-is  tertius  and  the  sulcus 
temporalis  transversus  primus  are  well  markeil,  but  as  the  gyms  temporalis  tranaversus  primus 
and  the  gyrus  temporalis  transversus  secundus  are  fused,  the  sulcus  temporalis  transversus 
secundus  is  a1)sent.  Opposite  the  area  of  fusion  there  is  a  sulcus  on  the  external  surface  of 
the  gyrus  temporalis  superior  which  passes  downward  on  tbe  inferior  surface  of  the  gyrus  and 
subdivides  this  as  far  as  the  bottom  of  the  sulcus  tempondis  superior. 

Sdlccs  temporalis  scperior. — The  sulcus  is  very  di-ep  and  presents  transverse  ^yn  on 
both  its  walls.  Its  anterior  extremity  stops  short  of  the  frontid  polo.  It  is  not  bifurcated,  nor 
is  there  any  transversal  sulcus  in  front  of  it.  At  the  poiut  where  the  sulcus  turns  upward 
liehind,  it  is  interrupted  by  a  superficial  nnnectant  gyrus  temporalis  medio-superior.  Behind 
this  the  sulcus  passes  upward  aud  a  little  backward  into  the  gyrus  angularis  to  within  1  cm.  of 
the  sulcus  interparietalis.  The  sulcus  intermedins  primus  between  the  gyrus  angularis  nod  the 
gyms  supramarginalis  makes  a  superficial  anastomosis  below  with  the  anterior  part  of  the  sul- 
cus temporalis  superior.    The  anterior  portion  of  the  gyrus  angulons  is  cut  across  by  a  sulcus 

S7B 


»lllch    oil«ntonxi..<i  alirivn    .Ilk    II.  ,  .  ~  " 

iiHii^ 
smsmsmm 

HlMHPMiiira  siaisucK 
376 


LcWCLLtK  F.  B>»n»  gi 

flrnra  ,,™,mn.  Tlil.  fonn*  nn  snide  of  IS'  with  lh«  lonKn.1  nnhTo  |,»t.rinr  .linm.<.r 
ot  Ih..  h.iiil.ph.n..  Till.  (li.lniKv  fn.tn  llu  rnmiM  aiil-rior  hciriaiutnli..  lo  tbi)  nuiiiu  pclirlMr 
AwTudra.  la  -,a  cm.  Thii  niniim  |»i»l..rlor  n«-<.ruli.ii«  k"-»  "IT  nt  iin  niiKl-  ttl  IW  iiml  !•  1 « <■„, 
loiiK.    llio  mmiu  |>™tirl.>r  .li«.ii.li'U«  im.i.im.«  1.6cin.  In  linxlh.    Th.r».iipi».,ir»  lo  Iwoiilv 

QUO  anlLtlur  .ul™.,  11..,  riuuw  anU^rior  ii..-..n.l..ii..  Inil  „„  cl,«....x„ti,-  ..11 ,  ni,llii„.i,lurT  miuu. 

aiilinor  huriroulnlw  imIlcatliiK the  llrnllii  o(  Ibe |«ir»  trianifiilari.  i-u,.  Iw  maUi. out, iiilliui, ouli 
a  few  mm.  hilo  eliu  nnlmil  milialuiK'i'.  ' 

8iL.T.  iMTaALi.  I  Roland.].  The  ranllal  ..itremllj  fall.  t„  „.„ch  by  ll.r,  cm.  (b.-  junction 
of  the  f«ta  comma  „||h  lb.,  tad...  mwlkli^  not«llb.l«n<lintf  Ih,.  fuel  that  the  .„|c„,  .in^rnll 
cillH  lulo  the  faci,.,  c..nve«n  lor  »  dlalaue,.  of  1.2  cm.  The  laleml  ..,l„.„,hv  l»  coii.ii.uo,,,  „|fb 
Ihu  Kiilcu.  imliu.iilrolM auteH..r,  tboiwh  Ih.n.  1.  u  loH- aniiecliiiit  Kinu  In  the  il.|.lh  «|«,ritini; 

the  two     The  anterior  .ul»-ntral .: i,«  a|.i».arii  lo  wmnect  Ibe  ...leu.  e,  nln.ll«  with  the  Sylvian 

ll™iir..,  bill  o„  ,,ull,„„  a.iile  ibc  mar);fii  of  Ihe  latter  it  i«  ..,-n  Ibal  lb..  ..ilK,.„lral  miI™.  t.Tml- 
nat..  In  the  ...1,-lan™  of  the  inferior  mirface  of  the  operculum.  The^cnu  Inferior  and  Ibe  mm 
■upenoran.  Uitbnell  markiKl.  "^ 

Relativ..  lenKth  of  HuiciiMconlraliH fi.7  cm 

Alwolute  lendth  of  Huk'iiri  ccntraliH  -       ■       ■        -   tid  cm" 

IncIinBtien  (meaaurwi  m  conlinff  to  ElH.n.talI.>rj>     -        ■        -        -        ffil' 
Dlstaacn  in  a  utraliihl  line  ol  Ihe  medial  end  of  Ihc  muIcum  from  the 

frontal  polo jj^  ^^^ 

Ditto  from  the  occipital  |Kjle KT  mm 

Dialance  in  a  «tr«i|ihl  Iin..  of  the  lateral  end  from  thi.  frontal  |»le       m  mm 
Ditto  from  the  occipital  pole lUmm! 

SCLCC?   Pa.lCE!<TRALI.^; 

1  '■'"•'  •"/■■•■••ir  («..fciM  ,.r,pcf nfroK,  i„/^rl„r  ,,/  EI«T>lall,r).-Thi,  i.  only  ...perfldallT 
mnm.el,«1  «ilh  the  para  miperiov,  an  nnu^tant  gyrua  paaalnR  from  the  naaiial  .'«,rli„,i  „l  the 
!«.«.  of  the  Kyrua  frontali.  mcdiua  to  the  gyna  centrali,  anterior,  l«.|nB  d,-.,te.«,l  lalow  the 
.urfac,  by  n  .hallow  .ulcn,  only.  The  lateral  extremity  of  the  .ulc.H  ia  0.«  mn'i.  fnnn  the  mar„in 
of  the  Sylvian  fiK.ure,  there  Ix'intf  no  «,.,«initln(t  .ulcus  diagonnli.  on  Ihl.  .ide.  The  nwlial 
e.lrem.1  y  pa™™  in  front  ol  the  biternl  extremity  of  the  pari  superior.  Th,.n.  1.  n  typical  anterior 
Mffittiil  mniua  (ramu.  horizontals  of  CiumlnKham)  paiiatag  foi-nuitl  and  a  little  m.^lialwartl  into 
the  »ul»lance  of  the  Bynu,  frontali.  mediia.  and  terminalinK  in  a  lrun»ven«,l  .sul.u.  0.8  mm  lonir 
The  lateral  portion  of  the  foot  of  the  gyrus  frontali.  melius  is  ronnect,,!  with  the  foot  of  the 
gynia  frontalis  inferior  by  an  anncctnnt  gynia  0.4  cm.  in  thicknras.  The  latter  pavents  tbe 
amistomosis  of  the  .ulcus  frontalis  inferior  with  the  .ulcus  pnwentnills  interior.  The  posterior 
Mtn.m.ly  of  the  .ulcus  frontali.  inferior  almost  bisects  Ibe  angle  lormid  liv  the  sulcu.  nnreen. 
trails  infenor  with  it.  nimua  iwgittali.  inferior.  ' 

2.  i"or»  aiiperior  (sa/cii.  imrcenlrnlia  »u,Hrior  of  £f.er«/.iH,.r).-This  Is  an  irnimlar 
miens  3em.  in  length.  It.  lateral  exl«.mlty  has  a  .hallow  sagittal  l,.s«  1  cm.  in  l,.ngth  Its 
medial  ..^tr..mity  piiss...  mwlialwan!  and  a  hltle  forward,  and,  shortly  la-foro  frminaling,  lK.nds 
.haiply  iKickwatd  into  the  gyrus  centralis  anterior  to,  and  1  em.  from,  the  mijial  mt.rglu  ot  the 
hemisph.Te.  The  sulcus  frontalis  superior  is  continuous  wilh  the  m..<liul  extn'mity  ot  this 
.ulcus.  One  and  one-halt  cm.  latendward  from  this  anastomosis  a  ramus  .ngiltali,  posterior 
passe,  backward  into  the  gyrus  ec-ntralis  anterior,  causing  a  deaeetion  ot  that  gyrus  and  givimr 
nso  to  a  knee  in  the  sulcu.  ceutrali..  6 J  u»  auu  giving 

a   I-an  'i'-'lialu(mlcu,,,nrcenlralumeaialuofeijfri,tnilUr).-ThU  is  n.present..d  by 
a  short  sulcus  in  the  gyrus  centrali.  anterior  between  the  medial  extremity  ot  the  pars  superior 
s The  deformatioQ  ol  tha  homispkere  ia  bardeDing  aiakai  this  maaaaiaaiant  of  donbtfol  Thine. 
877 


82   Dkhoiftiom  or  Bum  *«p  Bfi»al  Co»d  i»  H«»«niTA»t  Ata«u 

otlhf.111™.  nmcroln.!!.  .nd  lli«  mlcur  crotrmll..  II.  ronlU.1  nlmDlly  l««ti..  2  mm.  tmn 
th.'  mAM  miirKln.  Th.  nulcui.  hw  •  lt«l..T.T»il  llml>  «t..|i<llnK  <IIb,h1t  loWnl»»nt  tor  . 
•Il.lanc  i.t  l.li<m.  11  Iheo  lunw  >l  >  rl«hl  •nKte  .ml  ran.  wKilUlljr  Uckmid  for  1cm.  to 
UTmtali!wllhln0.4om.ottl».|»ic«Mll»Tiiir.  

Slui  »  rio»TAi.u  wrMioi.  Tl»  .ulcm  U  mnllnuou.  .upfrtlctally.  II  l«  prmralwl  Iitmi 
uiiillw  «llh  lb»  iHir.  Inferior  o(  th.  .ulcu.  priretotmU.  b,  n  .uperiid.1  aniHitanl  ((vru. 
.•xUMKltaK  Ltwiin  Ih-  piir.  op^niilnri. of  lh« Kyru.  froi.  ili.  luf.ri.».  «ncl  Ih.  liiLnil  pn^lon of 
111.'  fn<.l  of  th-  gyni,  fionl«ll«  m..<llii..  It  li.-gln«  l«-hlml,  cl.«.  to  Ih..  ^au\>-  form.^1  by  lh«  l»n. 
miiifrior  of  Iho  .ulciw  pnrc..nlmll«  wllh  it.  ranlii>  lunfiltiill.  .nlrrtor,  p«.»mi  forward  .n.l »  llttto 
lnli.nil«»r<l  for  a  dl-lan™  of  3.6 cm., ami eiul. In  Ihii  roUUlc of  ai>  ol,llqi«.ly  tran.ver«.  brniinal 
mllin.  3cm.  ImiK.  Tile  m.«li«l  limb  of  lhi«  ti'rmliuil  cron.  pl«-«  cut«  Into  the  gjni.  lr.i[italU 
iiKili,!..  to  within  0.7  cm.  of  Ihe  .ulcu.  frontall.  nu^liu.,  while  llie  hiLrnl  limb  cut.  into  lb.'  par. 

trian«ukri»  to  within  0.11  cm.  of  the  ruilimealarj  ramu.  ahoml horimnli.li.  of  the  a..un>  of 

Sylvhw.  Cutting  Into  Ihe  nrru.  fron«ali>  m.xliull.  from  about  Ihi.  mlchlit.  of  the  ...Kitlal  portion 
of  the  milnw  fmntall.  Interior  1.  a  .hort  meaially^lln.cti»l  ramu«.  EbemtalW.  cordf  re  T>e/en- 
wiMliiiM  In  illntlnclly  vWlile  In  Ihe  d.plh  in  front  of  Ihe  latU'r. 

SLUf.  r.o»TALi.  .irtaioa.  The  .uVu.  anaalomow.  behind  wllh  Ihe  upjKjr  part  of  the 
nn,  .uperior  of  the  .ulcu.  pnrcentralla,  though  they  are  partially  «paral«l  by  a  d«p  anneclant 
gvnw.  The  .ulcu.  at  it.  pclerlor  e.ln,mily  1.  only  1.6  cm.  from  the  medial  maridn  of  the  heini- 
.phere.  It  1.  not  piolon|i.«l  Uhlnd  the  .ulcu.  pnecenlrall.  Into  the  gym.  .■.■nlrall.  anterior. 
It  pa.««  forwarrl  and  a  little  kUnvlward  (in.tead  of,  a.  u.ual, me.llalward)  and  fonn.  in  fr..nl  a 
.uperlictal  amwlomo-i.  with  Ihe  .ulcu.  fiouUiU.  mediu.,  an  annectant  gyru.  making  the  com- 
mimication  a  very  .hallow  one.  The  .ulcu.  I.  not  lnt.m.ptcd.  It  pn-enl.  lncl.ur.«  into  the 
gyn«  frontall-  .uperior  »l»iTe  and  the  gyru.  fionlali.  m.-liu.  l.low.  In  front  of  the  ana.tomo. . 
!rtlh  the  .ulcu.  frontall.  mediu.  1.  a  .hort  Waled  obbquelj  ,-iltal  .ulcu  , ,....!  iu  front  of  IW. 
again  a  troa-rerwd  .ulcu.  2.6  cm.  long  on  Ihe  laelMi  conveia,  a..d  exlendlng  for  1  cin.  upia.  the 
facie.  medkU..  The*  two  imlatcd  .ulcl,  although  behind  the  .ulcu,  trontomarginab,,  may, 
perhap.,  be  n..(jarded  a.  Interrapted  Mgment.  of  the  anterior  eitremity  of  the  .ulcu.  frontall. 

"""  Sci.cc.  TOSTAU.  namc-The  .ulcu.  on  thl.  >lde  1.  ^ery  Irregular.  Oiw  cm.  in  front  of 
the  anterior  termination  of  Ihe  ramu.  anU'rior  of  the  Inferior  portion  of  the  ..Ucu.  pr.ecc_nlmll. 
i.  a  lran.ven«l  .ulcu.  3  cm.  long,  .hallow,  and  unconnected  wllh  other  .ulcl.  One  and  one- 
half  cm.  farther  forward  the  .ulcu.  frontall.  mediu.  proper  begin,  a.  a  tnui.ver«l  l»i™l  piece. 
The  nu*al  exiremity  of  thl.  form,  a  .upeiflcial  anaatomoai.  with  the  .ulcu.  frontall.  .up<.™r. 
Pa..ing  forward  from  the  middle  of  thl.  ba»l  .ulcu.  a  .agiltal  .ulcu.  eitend.  1.6  cm.  forward, 
and  then  bifurcate.  Into  the  two  limlia  of  the  .ulcu.  frontomarginali.  of  \\  emicke. 

Scwi-s  cisocLi.-II  con.l»t«  of  two  piece.,  the  par.  po.lerior  and  the  par.  mtermedm. 
being  continuou,,  Ihe  par.  anterior  being  »paral«d  from  the  real  of  the  .ulcu..  The  par, 
anterior  begiu.  In  it,  u..ml  po.illou  between  the  genu  corporis  callo,!  and  extend,  'o™""'  «nd 
then  upward,  cutting  through  Ihe  medial  .in^ace  of  the  frontal  lol«  to  reach  the  margin  o  the 
hemUphere  about  4  cm.  behind  the  frontal  lobe.  The  par.  intermediu,  commence,  about  1  cm. 
in  front  of  the  anterior  extremity  of  the  corpu,  callo.um  and  in  the  plane  of  the  .upenor  .urface 
of  that  .truclure.  It  curvi,  backward  approximately  parallel  to  the  crirpu.  callo.um  and. 
Incoming  continuou,  with  the  deep  par.  posterior,  pa,«,  up  behmd  the  lobulu.  paracentrali. 
to  the  margin  of  the  hemLphere,  and  even  extend,  for  a  di.lance  of  1.3cm.  upon  the  convex 

"'*  Scurr,  OLrACTO..c..-0ne  cm.  deep,  4.1  cm.  long.  It  pa.»»  forward  and  dightly  medial- 
ward,  but  faU.  to  reach  the  mwUal  margin  by  0.4  cm,    So  amwtomoK., 

M8 


I.1W1M,T»   P.    B««I(| 


.™l";u3ruJVizLr,l:T:'::,rr:r";^^    - ■' 

Acduo.t  ,,u-,  UP  rat  u)ir.  rio»i.i,., 

t^SHiSSS^-f :  "■  — 

Ik.  Uepth  with  tb.  lulcu.  fmnlall,  li,«lm.^    ,h.  1^.1^1'  '" ''"""'  "■»«'""•"•  "■ 

.lm™i,„,|„lj«:r».th.g,^,.    Still  mor..nLrJ,rr       ■' ,  ""  '"'""""-'l  ">"'■'  cluing 
from  behind  .nd  „«,,  the  3l.l  Z^r^o™^^  ",'.°  °',''""'"  """"  ^'^  ™-  W.  I«..lni 

w S:;u:;-s':-ttru.ro':;:rprv'd ;"'™"'T  -  "■"'•■" "-^ -■ 

oeiitrali.l,bi(um.ted.  •  ■«»"  wnveia.    Tte  pclorior  e.lrcmit,  of  Iho  ,uku,  p,.™- 

SuLcrs  iNTiaPAuruus: 

lalemlwaM  a-d  then  f„^  a^d  ^inci"^  .ulS^llr''''';',"'  ""  "■""'"'.h-.,  c.r^ 
cu.  ceDtmli,.    The  pa™  tafenor  U  an  obnai^rr^n     ^  '  T' '«™™'"  ■-■'■"w  to  th„  ,u|. 

which  «,„„„,.  ,h„  g^^  „„,^u,  I»»t„riorw  h  ^  w"„ btmnvir  ■""  """"T  ''^  "  «■"" 
from  «  deep  ,ulcu,.ubce,,lm)i,po.Criorbv  as  ,.  SZr^r"'"""'-  "  "  "•I»"'<«<i 
with  the  lobuIu.pariet„ll«  inferior  ■"""''«>■'■■<«'» 'hsKJ-nu^ntralispctorior 

;nferi„';.sr^^tGr:;cr^;risr.h  Tbr-"  "■■' ""'--  •-""-""^ 
-uin.  parie...  ,n,eH..  '•  ^-^^^r^r u^rn^ :z::r;  ■.rz^;^^^^ 

379 


n 


Descr.pt.os  o,  Bba.k  and  9p.s*l  Co-d  .n  He.ed.t*bv^Ataxiu_ 


ihe  ™lcu,  p„rocipl.aU.  behind,  and  wiih  th.  sulou,  parietali.  »uperior  n.^iially.    In  the  dep.h 

Sci/:l-a  »i-BP*»iET»i.is.     Il»  ant.nor  extremity         ,,7   It,  msterior  eitremilv  is  acparatnl 

,ul™,  ™bpnrietali»,  l.i.ect,  the  pm...uneu,;  ,t,  "W"*^f  ™   ^^^^^^^^       „,peri„r.    The  anterior 

its  uppT  extremity.  .    ,     „^„  of  the  hemisphere  to  |ioinl 

F,ss<BAPAaiETOoc<.plTAUS.-D.8tance  «"°"''^°""™' T,^^  „,,.rf,  i.-  cm.  upon  the 

„r  junction  .ith  the  tnmens  ns»«r»  "^"l""-^;*™;,  „^^°.  "::n,tEcker  exists.    The^nper- 

fncies  convexa  and  ends  ,ithou  btfureafon.    A  t,,,  c^l  ^J™'^^  »^"  e„neo-pra.em>eu,  at 

flssnra  i.  separate.!  from  *■;«»■-, '"-^^IT^^^^^Vs^^p^pr*  ^^^^  a  sinuous  course  to 
extends  tarn  the  cuueu,  to  the  l?y™""Wd>-  ™  "^i^i/cm.  upon  the  tacie,  convexa.  A 
the  margin  ot  the  hemisphere  and  extend,  tor  a  d,s^an«,  Of  l.^c        I»  „„„,„  „„„i„g 

sulcus  aap.talis  interior  cturei  (Retzm.  pas«>s  throngh  tte  ^°-'  P;^^,^,^^^„  „,  ,.i  ,^.  „p„„ 
approximately  paiaUel  to  the  fissura  calcanna.    It  extends  also 

the  tacies  convexa.  ,        „„ti„iy  separated  above  from  the 

SeLces OCC.F.TAUS  T»Av»vE«s.».-Th,s  .s  a  *«-P  ™''^'^^  ,,„! ^^,  0.6  cm.  broad.    The 

:-rr.t:i:JaX'rrprx'?iL"a'-:tr^terior  extremity  of  the  lob. 
parietaliB.  There  is  only  one  such  sulcus.    It  is  2  cm.  long,  begins  0.5 

cm..rr:==--^ii-:;rrr"t 

880 


Lewellyh  F,  Babkeb 


85 


Sulci  TE«poRiLEs  tbassvebsi  of  Hcsciir  _TI,n  ..,i„.    .        h"»"»- 

turn,  „pwaM  U  a„a,.„,„„,«  f^J^S-.  J:  et  £  ™TJ,  1":^^ 
mcta  with  the  ral™,  te3™7,    infX     A  f'"™'" '''''*"°' "■'»'«""' ^"'■»'<'- 

SSSiaSilgi 

ward  £^5 crTinb™"™;L'T''°'  '™- '"'"'"'  '"^  '»'"'  '■^^'''  "-='  ™-  "act- 


il  1 


the  top  piece  to  n  ,-.h«ped  terminal  .ulcu.  complei.  Between  it.  posterior  eitremlty  nnd  the 
lower  Mtremity  of  the  milciis  oocipitali»  lran.ver.iiB  a  third  gyrus  connect,  the  gym.  temporalM 
interior  with  the  gyms  tuaiforrai..  ,.,.,.  ,^  ■    t„„.  r~,m 

FissfBA  coLLiTEBALis.  This  Is  shallower  than  on  the  nght  side,  is  separated  in  front  from 
the  gyms  hippocampi  b,  a  long,  narrow  gyrus  which  run.  from  the  incuricl  i«lu.  t..nip..rali8 
to  the  middle  of  the  gyrus  hippocampi.  Behind,  it  end,  near  the  posterior  cxtn..m.ty<,f  he 
hemisphen.,  in  an  oWlquely  transversal  cross-piece,  the  medial  limb  of  which  goes  l"'"«-"  '^= 
two  vertical  piece,  of  the  ^shaped  sulcus  complex  at  the  posterior  enlremily  of  the  .ulcus 
temporalis  inferior.  The  gyrus  lingunli.  is  .ulxlivided  by  a  Mgittal  sulcus  which  anastomow, 
in  front  with  the  flssura  collaterali,  lielow  the  anni.ctant  gyrus  rhiuencphalo-lmgiuvlis. 

ScLci  iv-,CL...-Quldberg's  central  sulcus  of  the  island  separates  the  postenor  lobe  with 
its  two  gyri  from  the  anterior  lobe  with  its  four  gyii. 

THE  CF.REBELLCH 
(FiKs.  21,  22,  2.1,  24,  and  2S) 

The  eerebellum  look,  a' little  small.  It  has,  however,  been  distorted  in  the  hardening 
process.    The  actual  measurement,  are  a.  follows: 

Length  (anteroposterior),  in  the  middle H  *""' 

Rifiht  side  (maximal)       -       .       .       -       ti,i  cm. 

Lilt  side  (maximal) 6.6cm, 

Greatest  transverse  diameter 42  cm 

Greatest  height  or  thick-. ss  - 4.*       . 

The  distortion  has  Batt'-ned  tl>..  verticil  and  increa«!d  the  anteroposterior  diameter.     The 
incisura  cerebelli  posterior  is  deep.  , 

l>™.i«.-The  lingula  cerebelli  has  been  torn  in  reparaling  the  cereU-llum  from  the  rest  ol 
the  brain  stem.  It  is  weU  developed,  i,  not  atrophic  or  rudimentary,  and  is  a  hngula  simplex, 
not  duplex.  The  vincula  linguto  cerebelli  are  symmetrical  and  not  separated  from  tho  lingiUa 
by  notches  The  two  sides  of  the  posterior  free  surface  of  the  lingula  are  symmetrical.  Ihe 
anterior  surface  is  firmly  fusixl  posteriorly  with  the  velum  medullareanterm,. 

Lob„lm  cen(ro;i».-Thi,  is  well  developed.  It  Ue,  almost  entirely  on  the  anterior  free 
surface  of  the  cerebellum,  but  it,  most  superior  portion  is  visible  from  (ho  facie,  superior  and 
thus  enter,  to  a  slight  extent  into  the  formation  of  this  surface.  On  it,  anterior  smrface  eight 
Hamlu.-,me  are  present,  separated  from  one  another  by  depressions  The«.  Jio„rf,,.^(.,(c  run  m 
general  pamll.l  to  one  another  and  vary  only  slightly  in  thickne,,.  The  upper  hree  ««"<"■«»» 
are  marked  off  from  the  ala  lobuU  centraHs  on  each  side  by  deep  indentalionsi  below  these  throe, 
however,  the  junction  i,  grooved, but  there  i.  no  incisure.  The  delimitation  is  more  sharply 
marked  off  on  the  left  than  on  tho  right  side. 

Tho  posterior  surface  of  the  lobulu,  centralis  is  slightly  concave.  It  present,  seven 
BanduilhtTot  approxim,atelj  equal  width.  There  are  no  incisure,  between  the  BamluyaUle  of 
the  central  lobule  and  it,  alie. 

The  apex  of  the  central  lobule  is  rather  blunt. 

The  dimension,  of  the  lobulu,  centralis  are  as  follow,: 

A.  CM  lacies  anterior: 

1.  From  above  downward  (apex  to  lia,e)-in  the  middle     ■        ■  n     mm. 

(Stilling's  normal  measurements  vary  Ijetween  10  and  Ji)  mm.) 
S.  From  right  to  left—  _  g    ^^ 

Alwve ,  ',  ,n        ,'       " 

(Stilling's  normal,  4- lU  mm.) 

Middle '•°°"°' 

(Stilling',  normal,  6-10  nun.) 


J 


B.  Thlcknciis: 

Just  beneath  apex 
In  the  middle 
At  the  base 


Lewellvs  F.  Babxeb 


37 


i    Dim, 


anterior  free  surface  of  eac.Ltor,ubdMdvT.f™""'  ""''   ""> '"■'"^'■ium   p„„ti».    Tl... 

"Pp..Tt™ar.,tho,horte^  iLe:!  d„'"Tr.,  r,  'n  ""'"'"'"'■''  ■"'■""■"■"  '■>"'"■!  '^" 
Tlifre  ta  no  fusion  with  ILe  bmchhl    '''•.""' "'•''"1  all  the  way  to  the  poKt,.rolat™l  n.arrin 

The  l..ft  al»  also  pn-l'l^l^^tZZT'TZT l7  Y""  T""''"'"'  "'  ""> "'"  "•^"■ 
the  .u  ri  from  „„,,„r  »i,„a,ed  uoar  tC  html  at^  ■»  «  Weuey  to  a  radial  arra,„,,„o„,  of 
-far  this  a,«x.    Tho  ,«,terior  fr,"  ./Xl  "  .1       ',  ''  "'"'*  "  ■»' ""iHUvid,  J  exi,t, 

«ulci,  „„  the  left  .ide  hi,,  ,r  ai7»  Z^Zl  ,'"  1:  >■"■:■""  »""-«»A»i  '!«>,.l,n„.te  au.l 
anterior  ,„fae„  of  the  ala  lobreeu.r^^^a™  1'  fow"  '"''"■"^'"-    '^'^ '^"■•*"»  °'  "■» 


From  above  downward: 

o)  Next  the  lobulus  centralis,  riuiit  wide 
leftside     - 

0)  In  the  middle,  right  wide  -        .        .        .  ' 

left  Bide  -        .        .        .        _ 

„,  I,  L.    ,      .,..  'Stillintis  averaffo,  7-8  mm.) 

c)  Behind  imddle  of  brachium  j^ntia.  right  Hide         - 
left  side 
(Stilling's  average,  4-")  mm  i 
Width: 

")  t'pper  margin,  right  side  -        .        .        ,        . 

left  side 
. ,  T  (Stilling's  average,  lG-22  mm  1 

6)  Lower  marBin,  right  side  --.... 

left  wide         -...__ 
(Stilling's  average.  14-20 mm.) 


12  mm 
11  mm 


10  mm, 
10  mm. 


7  mm, 
10  mm, 


18  E 
22t] 


16  mm, 
18  mm. 


.od.he\?;zi;*t'4h:'„t;"nLit:' '""  """""^  ™'"'""  »»•'  "^ »"» »"•-"  "-'°p«< 

lir,.  porliou  of  the  cuta™  *Lt~.   t™™rb™    "°  ""■,  '°.'"'""   "■"'™''"  "■"•  ""' 
superior.    Thogeneralconfimra  taStl,        I        '    uT'  """'''  """  ""'''■'  "'  "">  ™"nw 

.pond,  very  clcSTly  to^wfdT^rU^'sXTrm^ 

the  mgittal  section  (FiR.  26)  ha,  in  Ihi.  re^    a    ■  .  .  ™'""  "  »''«'  '^P^''.  ""^"bI" 

that  the  posterior  pati  oMhTsiu;    p^lX^tX  I  ""Tn"",'  '"""  """  °'"""°  •■'"""'» 
tho  ix>.terior  part  of  the  wonT  ^  *■    °'  ""'  '"^^■°i»P''ere  and  not  through 

383 


,:^l 


\'^4i&^sB^BSM 


88    Dercbiption  or  Bbain  and  Spinal  Cord  in  Uebbuitaby  Ataxia 


Upper  Burface: 
Right  Bide '  - 

1.  Near  vermin 21 

(StilliDK'B  noriual,  17-19) 

2.  Near  pons 1* 

(Stillior  a  Dormal,  12-14) 

3.  In  middle,  between  vermiB  and  ponB ^ 

(Stilling's  normal,  22-26) 

Left  Hide— 

1.  Near  vermis         ...  14 

(Stilling.) 

2.  Near  pon» ^^ 

.1.  I.i  middle,  between  vermis  and  pons 23 

The  six  wnllH  {Wande)  correspond  to  the  nix  Wfintle  of  the  montic  Jus.  The  first  wall  is 
doubled  on  the  left  side;  the  swuud.  on  the  right  side.  The  fourth  wall  iff  but  slightly  devel- 
oped, being  represented  by  a  projection  in  the  depth,  between  the  third  and  fifth  walla. 

The  (UmeuBions  of  the  lobulus  qmidrangiduria  are  as  follows  ou  the  Jpper  surface: 

1.  In  sagittal  direction  next  to  monticulus,  left  -        -        -  43  cm. 

right  -        -        -  4.6  cm. 

(StillinK..13  40  mm.) 

Ne«t  to  brachium  pontis,  left 2.3  cm. 

I'rljt     -  2.4  cm. 

(citillinK,  18-20  mm.) 

2,  In  transversal  direction  on  anterior  margin,  left     -        -        -        -  g.Oom. 

right      -        -        -        2.1  cm. 
(Stilling,  28-35  mm.) 

oHterior  margin,  left ^-^  **'"• 

right 5.7  cm. 

(Stilling,  U5-72  mm.) 

Lobulua  gemilunaris  auperior.—  On  the  right  side  the  number  of  RandwUMe  on  the  sur- 
face near  the  incisura  cerebelli  posterior  i-s  five;  on  the  left  ^ide,  seven.  On  the  right  side,  on  the 
surface  in  the  middle,  there  are  tliirteen  iJanditnWa^c;  on  the  left  side,  fourteen. 

The  maximal  sagittal  measurement  o*  'he  upper  surface  ou  the  right  side  is  1.2cm.;  on  the 
left  sidr^,  1.8  cm.  The  cur\-ud  meiisuremrnt  transversally  along  the  posterior  margin  is  on  the 
right  side  1.5  cm.;  ou  the  left  side,  6.5cm. 

Lobulua  semilunarin  inferior: 

Num     r  of  Randw&Ute  near  vermis,  right 8 

left 10 

"             "             "             lateral  margin,  right    -        -        -        -  4 

left  -        -        -        .  3 

"             "             "             in  middle,  njht 8 

left 9 

Maximal  sagittal  measurement,  right                  1.7  cm. 

left 2.2  cm. 

Maximallength  of  posterior  margin,  right 7.4  cm. 

left 7.0  cm. 

8M 


^Lkwellys  F.  Ba»eb 

i'Otntliitigrarilit: 

Number  of  «„„rf„«.,e„,„„,^^,.^^j 

..  ..  I»'t        ■       .        . 

lateral  margin,  right 

Majimal  Mgiital  meanurement,  r.iht  -       .'"".    ' 

Maiin,.U.Bittal„ea.urem™t  (curved),  right   -    "   .    " 

Number  ol  «„„<,«,„„  i„  „m„^.  „,  .„,,,.__^  ^^^j__^^^  ^.^^^ 

S^jittal  measurement,  in  middle,  right      -  .  ''" 

Lcncth  or  iioBterior  margin,  right 

Flocculun:  '       '       '       • 

''""''»^' ■"*'""«""»'«  on  inferior  .urtace,  right    - 

Dimension,  of  interior  .urfaee,  right         .    '""  " 

left 


-  6 
3 
i 
3 

1.1  cm. 
OBcm. 
01)  em. 
tl.U  em. 

1.T 

12 


(injured) 
1 3X0.7  cm. 
1.2X0.9  cm. 


iia„dMfe,e  on  the  ".cdial  .urface  of  U,rm^a]  „"?.       .T'  '"™"^°»-"-    The™  are  „m. 
face  of  the  kteml  musa.  ™**'  °"'"'' '""'  ""^  ™™  ""mber  on  the  lateral  aur- 

The^rXK^rrtle™^^^^  't-edia,  ^  .he  aa.o. 

surface  of  the  lateral  mas«.  *^^  *'*^  "'^'^^  ^'»«'';  «"•!  seven  oa  the  lateral 

MICBOSCOPrCAL   EXAMINaTIOK   op   case   XX 

MEDDLLA  SPINALIS 
Pr^  (FiK3.45,«*nd35) 
DLOOD-VESSELS  OF  THE  SPIN*r    rnon        Tl , 

vea^ej,  ,„„„<,  „„,.  oo„p„^":  h  Z'iS.^iol'IfT'r'  "  '^'™  "-'y-  ^ke  blood- 
d.atnbutioo  of  the  larger  vessel,  i,„„ral  The  t^.i^"'"™"'  ^^''-  '""'  R<«'-  The 
posterior,  posterolateralia  e.  M.r.^^'^^.^Zt""'  '?'°'"'-"-"''"nle,olatemli», 

^.,S-:rirs:t:rtaLtf  tr5i5^^^^^^^  -"  -  ~  - 

harfening.area.  folio,.,,  °°'  °'  ""'  """*  "'  ""o  «■«  ''^bar  aegmeol,  after  formol 

Anterior  posterior  diameter 
Transverse  diameter  '        •        -        -    0.7   cm. 

followlf"""""'"^'''-''^^™''-'-'''.^  level,  o.ea;u,edb;P.,e«ort::;^„  are  as 
White  matter      .... 

Gray  matter    --..."''""        8.870  sq.  cm. 
Ratio     -        .        .  '        '        "        ■        •    3.583  mi,  cm. 

1:2,3 
886  ^ 


i 


40    Description  op  Bbain  and  Spinal  Oubd  in  Hbbeditabt  Ataxia 


The  nDtt'rior  am\  jxwtf  rior  rootn  of  the  Bpiniil  ntrvea  show  no  altt-ratiou,  except  jioHHlbly  a 
Blight  iui-ri'HM)  in  tlie  emloneuriiiin. 

Tlie  piu  mater  is  a  little  tbickenod. 


ThicknPHH  of  pia  ovnr  funiculuu  latt^raliii 
Thickn^MH  of  [lia  over  funiculus  puHterior 
Thickneba  of  pia  over  funiculus  anterior 


0.076  to  0.155  mm. 
0.m8toO.U81  mm. 
O.UI7toU,OH7miii. 


The  subpial  layer  of  neuroglia  (GUahnllf.  of  the  Germans)  is  much  thicker  in  the  lumbar 
region  than  norinal.  The  avenifft?  tbickutjtw  ovi-r  the  fuuieuluB  anterior  i^  0.4H  mm.  Thuro  un- 
t»To  triauf,nilar  indentations  in  the  anterior  part  of  the  cord  where  this  glial  layer  measures  0^1 
mm.  and  0.243  mm.  in  depth. 

Thicknpfw  of  Kubiiial  Inyi-r  of  ^lia  over  faHciculus  Liiuaucri  0.iri2  mm. 

Tliifkm'W)  of  subpial  Injft  uf  ylia  ovvr  funiculuM  potiterior 

(lateral  part)  0.017  mm. 

Thickness  of  subpial  layer  of  glia  over  tuniculut)  putjteriur 

(Doar  median  wptum) O.OM  mm. 

Stitdy  of  sections  stained  with  Weiyert'H  myeUn  $heath  stain  or  tvith  iron  hnmatoxylin 
fttain  of  chromicized  tissues. —  The  fasciculi  stain,  on  the  whole, '  annally.  There  are  nodefjen- 
erated  areas.  An  exception  is  to  be  made  for  the  middle  root  zone  (FIech«i{f)  of  the  funiculus 
posterior,  which  is  lighter  than  the  n>st  of  the  funiculus,  and  the  glia  is  more  abundant  than 
normal  in  this  lightened  area.  In  view  of  the  fact  that  the  nucleus  dorsidis  and  the  direct  cere- 
b(;llar  tract  higher  up  are  degenerated,  it  is  interesting  to  note  that  it  is  this  middle  root  zone 
of  Flechsig  in  the  lumbar  cord  which  contains  those  posterior  root  fibers  which  nm  in  to  end  in 
the  gray  matter  of  the  nucleus  dusaiis  at  a  higher  level.  Aside  from  the  alteration  in  this 
middle  root  zone,  the  doi'sal  funiculi  show  no  change.  Lissauer's  f\sciculus  is  well  developed. 
The  pyramidal  tracts  and  fasciculi  propiii  of  the  funiculus  lateralis  look  normal.  No  alteration 
Clin  bj  niiido  out  in  the  funiculus  anterior.  The  fine  medullatod  fibers  (tenninals  and  collat- 
erals) which  pass  through  the  substantia  gelatinosa  appear  normal  in  numlwr  and  distribvition. 
The  anterior  and  posterior  white  commissures  show  no  change. 

Sectio7is  stained  by  Nissl's  methodt  in  thionin,  and  in  toluidin  blue. — The  anterior  horn 
cells  are  pR-sent  in  nearly  normal  number,  though  they  may  be  slightly  reduced.  No  change 
in  size,  shape,  or  distribution  is  discoverable.  The  internal  morphology  of  these  cells  appears 
to  be  quite  normal.  The  nuclei  are  centrally  placed,  and  the  nucleoli  stain  intensely.  The 
stichochrome  arrangement  of  the  tigroid  masses  is  well  preserved  in  the  dendrites  and  also  in 
the  perikaryons.  Abundant  masses  of  lipochrome  can  be  seen  in  many  of  the  anterior  horn 
cells, 

Pabs  thoracalih. — The  cord  has  been  a  little  flattened  on  rnmoval.    The  dimensions  are: 

Anterior  posterior  diameter  .        .        - 0.5  mm. 

Transver.Ht>  diameter  .        ,        .        _ o.9  mm. 

Average  diameter  in  the  two  directions 0.7  mm. 

Professor  Donaldson's  measurements  of  a  cross-section  nhow  an  area  of  white  matter  of 
6.955  sq.  cm.  and  an  area  of  gray  matter  of  0.t)73  sq.  cm.  This  is  a  ratio  of  1 :  13,"  which  is 
clearly  abnormal. 

The  anterior  and  posterior  roots  of  the  spinal  nerves  show  no  changes. 

The  subpial  layer  of  neurologia  measures  as  follows: 

'•Cf.  Dnnaldson,  H.  H.  and  D.O.  Davis.  Adeserlptionof  chart  showing  the  anasoftbfloross-Mctioas  of  the  huBftD 
spinal  eunl  ut  Iha  canter  of  each  dvinal  aetve,    J.  Comp.  yevrol.,  UraoTiUe,  Vol.  XIII  (1900),  pp.  1^-38. 


L'WEi.Lrs  F.  Babkeii 


iQtcKnriw  over  riinr>.i>i..  ^     .  "        ■■       - 


■  0,35  mtn. 
O.tiQium. 
or,  mm. 
0.22  aim. 


.  —  .-"-""r  i.unicmua  gracilis)  n^.,  ""• 

Aeo((on«  stained  u^ith    ii-  ■       ..  "  '  O.ZJaim. 

Bfi7 


42    D.gQ.iPT.oii  or  B.Ais  and  Sfikal  Oo»d  -k  H.;..piTA.t  At>«i* 

The  cell,  of  the  column,  po-tfrlor  include  (1)  the  cell,  of  the  nucleu.  domlll.  (Ctark.'. 
coluB^rS  the  ell.  ot  the  .r.an.l»  «cl«.l„n»  RolaudJ,  (3)  the  c-U.  o  ">«  -°»  '""" 
~Zfc.  limUanlc).  and  (4)  the  cell-  of  the  columua  po-terior  ,.ropm  (W aldejer  .  nud™.  of 

the  i°-";^»)-  ^,  ^,_,^,^,,,  „,„^„  ,„^^,  „        ,,  ,.„  ,h.y  ,^„  «""<-»  ™';-'yf|, 

.ppeaaKl  IhmuKhout  the  .hole  length  of  the  nucleu..  In  "-"  Y^'^rtahSn™  ^ 
visible-  where  any  cell-  are  Mt  at  all,  the  »uml»T  doe«  not  eic-d  tmm  one  lo  thr.»  in  a  i«c 
Znlw  The  te«  cU,  remaining  pre«.ut  no  chamclert-tio  .lt,.n,tU,n»  when  con,par,^ 
^Uh  t  henomal  ell.  of  control  pre,»mtio„,.  The  tigroid  n,a«e.  are  irregular  In  -.le  and  di.- 
rrlhu.rn°«™»ionally  they  are  ^ripher^lly  di,po«d.    The  nuclei  ,„n, be  eccentncall,  placed, 

"'"' '  AuTltaui o"f''r:!^c.ll«l  Gierke,  cell,  of  the  ,„b..an.ia  gela.in«a  ha,  ^.  made. 
On  comparimu  with  control  preparation,,  they  appear  to  1»  normal. 

The  marginal  cell,  of  the  ronal  layer  are  uornml  u,  numl>er  and  «p|».anmoo.  I  cannot 
detect  any  alteration  in  the  lriang.dar  cell,  of  Waldeyef,  nucleu,  ot  the  dor«.l  horn. 

Pars  CERVICALIH  AND  TBASalTIOM   INTO   MKDCLLAt  „-        ,  _,.     l 

S.c"'o«  .to.rf  by  Weigerf.  m,tko,i.  and  ,nth  .mn  »„.»a(o.-Bl,-..-The  degencrat..! 

„r«.  ,W1  co^plnd.  to  the  .Ltion  of  the  dir.^t  ce«,l-llar  tract.    The  area  u  larger  than  n 

JhTlh l™cic^rn  of  the  corf,  and  U«i„.  nearer  the  dormd  horn.    In  -c-tion,  tb""*^  *« 

unc«rof  the  -pinal  c.rrl  with  the  medulla  oblongata  the  deg,.nerat«.l  area  .,  "V"».«^y 

marl^  Hi  out.    It  i,  appmximntely  triangular  in  ,h„pe,  the  apex  of  the  Inanglo  l,eiug  on  the 

Tla  V  l^h  nd  oppiite  the  dor^l  horn,  the  1„«  in  front.    The  two  ,  d«  o    the  '™.»gle  »« 

Zmj  by    he  J!rip^,erv  of  the  cord  and  the  lateral  .urtace  o    the  lateral  pynmudal  tract 

Z^tivdy     On  one  .ide  ot  the  cord  a  large  bundle  of  pyramidal  tract  fil».r,  plunge,  te  Ij 

ZTXlho  degluemtcd  area,  iu.t  after  dcca^alion:  lhe«  Hbenin™ »„rr„und«l on  all  ..de^ 

b,Mhe  pale  yellow  glia  ot  .hat  part  ot  the  cord  from  which  fiber,  of  the  duect  cereWlar  trac 

lave  „l,*t'ent°rel^  dl«>ppea,ed  (ride  Fig.  41).    The  di.lauce  from  the "I«-'°  '>;=>»«  °' 

he  tri,  nde  i.  2 128  mm.,  the  width  of  the  ba«  i.  Om  mm.    A  few  .cattenxl  healthy  hber, 

emltain  the  degfnrratrf  arcs  a,  wa.  th.  ca«,  in  the  «.tion.  thjough  the  par,  thoracah^ 

T3a™chieflj  fi^r,of  very  large  caliber.   The  .ubpial  neurologia  layer  over  the  degenerated 

area  measure,  0.113  mm.  in  tbickne...  i  r  ,„„   i„  fm„t  of  the 

There  i.  .light  dillur«  lightening  of  the  area  eitendmg  tor  1  to  1.B  mm.  m  front  ol  the 

mainSeo  degeneration  and  with  the  high  power  it  i,  ««n  that  the  nerve  hber,  do  no 

Z,d To  cTc«.ry  tolSher  here  a.  they  do  normally.    Either  a  tew  fll».r.  of  the  direct  cer^be  la 

tact  have  uJnpSnt  in  tbi.  area,  or  we  have  to  deal  with  a  .light  lo..  ot  m»r,  in  the  ventral 

"•"TThrdo^uI^LdUhr™  i,  a  long,  narrow,  -■^•'"^,'tr';"'.f  ^''^'r-he^^ral 
margin  of  the  ta^iculu.  gracili,,  and  a  .till  more  di«u«,  .lightly  l.ghten..l  ^-.^  °!''/^° J'''"^ 
middle  portion  of  the  fa«;iculu,  cuoe«tu..    There  ha.  be,-a  an  actual  te.  of  hber.  from  the«> 

"'^''The fa^icuUcerebroepinale, contain  no  lightened a.ea.  in  the  cr«.*.lion.^Thi,i^^^^^^ 
al«.,  of  the  variou.  faociculi  proprii.  Helweg'.  ^ath  i,  not  di.tmgm.hable  by  any  color  d.Ber- 
ences  from  the  .urrounding  while  matter.  -.i  ,„■„«,..   i,;,„ —The 

Seclinm  riaimd  b)  Kissr,  mctlwd,  with  Ihionin,  and  with  ioluuim  '""-The 
ceU.  of  the  ventraThor^.  are  preeenl  in  normal  number  and  di.tributton.  The  tigroid 
^talatce  i!  abldant,  and  a  large  number  of  the.e  cell,  are  richly  provided  with  ma.«,  o 
UphZe  So  alteraiio-  in  any  of  the  nerv«iell.  in  thi.  portion  of  the  nervou,  .J.tem  U 
discernible. 


HDCLLA  OBLOMOATA 
T-„,    „  (P'««- ■^  ».  «i  «nd  «) 

of  the  m«lulJa.    B„.„..„;  ?W  .T.^'.hh 'r'.""""?.  °'  '"""■•  '•"'««l«'-l.  to  the  periph™^ 

he  „.r,  p..riph„,  of  .h.  .nedulla'h  ' .C  of  tZZ^'  ""I'''  "","  «"•"■  ""■■"•-"■    <>° 
Bbra  nrcuata.  eitenrn..  lep'uenition  h  Uiunded  by  «„„,„  niedulhited 

.h.«.lt::"-sszxr.LrhL:;;x™^^^^^ 

tri«eini„„|  „,.rve  l,x,k.  normal  "*'  <»«•'""''■•  tn.it.    The  .pi^l  ,„„..,  „,  n„ 

a..'  normal  on  each  .ide.  The  fibm, arcuatointernMrT-';  '"''  "'""'™  '""-'o"™ro  l™nl«l 
The  tmelu,  ,pi„„n,  „.  Mg,u,M  ami  the  ?lei  °M  T  n       ™  "''''"""  """"»  "PP""  ""™al. 

'""'•  "PP-'-nlly  having  ,„r„.^  ^nto  Ihe^^.f  ™?,r  "^""I'"^'  ''""l'-«PP^">«l  a.  thU 
appear,  to  bo  evenly  dark  and  the  Do.ll  „„  ^T.  .'*"'''°"°''-  The  latter  .truelu,,,  however 
root  flW»  of  the  n/rvu,  h;^lt:,!^^r„l  ',"  ZT"'  f"'"  ''  °°'  "--'"'-"l"-  Th' 
chao«e.  No  e,te„.ive  al.e'^on,  ha 'X:  ™1  J^^ ".".'T"  °l™'«'«-"«re-.  .ho» noobvlou, 
Ih.a  level  -miceua  nervi  hvuoi,lr„i  „„  i         ,       ■  ""■  ™™"'  """"aes  of  irrav  matter  >1 

aj-ee»»ni,m.eie„,,„„i,:;;^j:::t;a7i';-^-^^ 

o  the  ohvo  in  probably  .mailer  thi  n  noma     inS  '..  ""'">«■',"' "'""  '"  ""=  ^^  "">"er 

what  diminished  (f/.  Fig.  .M)  '       """•  """ '""  o'  "U  the  .IruetimM  seem,  wme- 

,c„,™"r  "'  """"^  ■""="'"  -  "^  — "  ".-o»,  „  .^,o»  or  .»^.,e„  „,  , 

nervettrS"'"  '"  "■''«-''""^-««""..-  Xo  alteration,  a«  vUible  i„  the  vestibular 

PONS   rABOLII 

centmli,  (c,nlr„,e  //«..6,„6o°^M. Tf  ™  °     ''    '-"""•"^  l^teml"-    The  ta»i™l„s  lefc-,„euti 
and  the  .ran,ver«,  fil.r.  of  the  ^„   ."llirnZLr  "?!"""'  "'■"■    '^^  '""'■■"'"''"'"  '"--o 
■n  the  par.  dor^li.  p„,,„,  „„j  S;™^™^'^jn«jrray  matter  of  the  fonnatioretieukri, 
hi  amount  and  distribution.  ' '"°"'  "' """  P""  ""tn^"  appear  to  be  normal 

CERKBEtL01I 
WRtDKlT  PSKFAEATIOKB 

.)Co^»..„„„e.-The,.miim^£;Zroir^SinWei.r.pre^.iou..    ,n 


nud.™  ill  llio  m.-diilk  nml  tho  n«ion  of  tha  iiaclovw  o!  tho  ruof  a.-e  o  proimuii. 

»ctiQi»;  lb..}-  u« l.ro«"l  111  ii|.p.iroiillj  Domiiil  oumWr..  _  ,, 

OTBciliH,  tlio  ByraaiU,  und  the  toDHlUii. 

„)SM      :(mc..r(i(-ali..-Nooll«alioii»ani<li«ermble.  , ..  ,.  ,i,.,  m,niiimni 

,.„„bof  .he  .pindle  ..ii*  8mn,.  i.»  ^xliuuiil  *--»  "^^^  ^  ,^i;  '^,  t  ^."."u. 
three  miuute  i.k.id.  ol  Rmy  matter,  whKli  beleiiB  to  ''"'"'f''";,,,.^  „,„.,,,„  ^,|„l««i». 
dentalu.,,  »bile  below  and  b.hiad  it  U  the  ■»'^'''""'"  l'^»  ,^"'  .,  '''^1"  '.toiitvideutly 
Beneath  II  and  In  tmnt  o(  It  are  the  flb^-rs  „.  .lie  ''"-''''7 -'X"'^'^:'  !,  I  Ji  „Zi-.  Ur^ 
,«,»,.,  IhrouKh  only  tho  more  lateral  and  poeti-nor  part  ot  tho  nuil.  a. 

""■"Tiv1'rr6Sa^™--trpt„,thro„«h  the  ^.eriorheadof  them 

nucleiu  and  through  the  posterior  part  ot  it»  .torn. 
Or.-«lc»t  Tprtic-al  iliamotor  in  »eclion«  =  2  mm. 

(irpatentsairittaldiamoter  in  HectieOrt  -  51a  mm.  ^,K,.l.ln 

0:-^to.,laattenin«ot,he  eere...lU.m  ..  awholo  in  '>;;; .•jl'.tt^^X;:  Mi!    T  T  e 

.ha.thever.icaldiame.eri,l«evor,.ma.o^ng^^...cr.^^^^^^^ 

;:tT:fnrr3S' meliXlu  l^.  ^rber,  o,  ganglion  e..,U  are  present  i.  the 
"""'Tj^nol.u.nenla.,,. -Only  three  .mall  Ulanda  o!  ganglion  cell,  are  present;  iLe«  are 

obvio  '1*^:^  «^:rorthrongb  l  m»t  -*\  r«x°yiS»  nr:t;s'':;™. »,» .en 

,)  -for,^  „,■  '«Kare.-The    amina,  ■T^""™  ^;j^„t"^l^^?A  iq" Lly  c.U  ^ 
develop.Hlaiidtu»  inlhtboc-nln,Uhlte,uh.lanoo     J^» '™r""^'J,°k  „,„  J,.    Vhe  filx.ra 
c„r«.^ndin«  to  tho  anU-rior  and  posterior  d»"»'''°"J°""^»"^'^;^^;^'^;,„,„„,  ,„ok  a 
ot  the  brachium  conjunctivum  (Stilling".  proceMUa  oeiehelll  ad  corpora  qua      ge 
little  thinner  and  the  bloodveMek  in  it  am  dilated.  ^^         , 

of  the  bnichium  pontia.  .      , , ,  ,  muvoluted.    Tb«5  cells  In 


LlwiLLTi  P.  Baku 


411 

n«  III  iHirniiil  pnimnillon..    .\„  nlfcrnlto tlj   hi ,    l'  -"■"lioinulnr.-,  I,.„  ,i|.,i„rt 

diimTiiilil...  "■■ni.ioii.  Mm  Ibnri  IW  (pmriil  •lliniiiutl.m  In  volnmi.  nro 

STi_nt  „r  r„„T»L  .n-iio»i  TH«oi-mi  <ti,M,i,u.«. 

w.r,i  „,,,.  ^''"■""''i-ir™:;^:^;;;;'^^  "■:  "'■"?"->.  i..-!- 

i-xenmity „f  th.. „„cl,,,. ,l..„i„„,,.    Tl„. m„.. „f  m..^„  J        i        '"' '"""""  "'  "'" »"•••"'" 
n.t  Mn,„,l,  or  .1,,.,,,^  .t..h,i,«  «U.r„(      „  "l  .  r     Th   TT;  """""'  "  '," '"— '  ''7 "I'l"!''-!? 

™bollf„„„|.  i„  ,hi,  ph,„,..     airil  i,Tr  ™     «r„'     7';i         'V"'"'"'  "^•"' "  "'"  ""= " 

-.. ji...  „ie.ih„  ,™„T,.  A.,  .h"r,i.,T:z"  r,' "'Ti;  ;r '-i-r'  "r" " -""  -^"^ 

""■  """l"""  '""liBil  1«  n  minute  mii».  of  imv  mnll-r  „       .i         J-'       "'  ""''  "•P"'«'nt»t'vo  of 

The  „hi,.,  m„„„  „,.hi„  .he  n,ic  rir, ;  ,ik,th?'^'w'  "'"r "' '""  "■"■"■"■ 

blo,xi-v««.|»  are  dn.l.,1.    Thi,  ,»,|lor  i,  „„,  T,"''^',,r  ""'^  Pn'Panitio,,.,  „„d  Ih, 

Welgert  pi<.p„n,lioi„.  corami»,„ii,  l»  .ell  H,.n.|„,»,l  „„,l  ,,„i,„  |„,„„„|j,  ^^  „,^ 

In  the  cm„«  „,e.l,„l„„.    Seetta  ,  thZlTh^^^'r    7"."'  "'"  ?""'"' '"""»  '""--W"! 

NiMfc  PurAiATtona 
that  the  Purkinje  cell,  i„The  he^lspi™  1^^ 'T,  't '"» «"^-™uld  .»■  l„„,l„„„.,e,„p, 
near  the  bn«,  than  at  the  .ummr„,The  iT  ^  °'"-  '"  ""'''"""■    "  "  'W"'" 

.er,™':riX.hr;d:::rT:h^ttoro/rh:iitr  ^!  "■' ""-''"  ■"•"• "  -'■— . 

The«,  mea„uen,e„,»  „„.  -malle  than   hi  l^^/^'^.'^''^"^^^  "f-  "^  ^  »  ••■.■ 0.1  „„! 

whan,  .hemo,ee,d„r  and  granular  ky'ra^  of  3Th  Li.        ?' ''''"'^'' """"''°*  *" 
d,.plh.     VonK(illiker,however,(rive,o»thenomnMM  1,         T.'  ''""''  """^"""^  "l-mu.  in 


Dnoatr*to>  or  Bttix  amd  Humi,  Ouii'  i"  n««iniTA.t  Ataxia 


•WolwnucWl.    Tl».,ne.llon."Ar.,th..P«rklnJ..».ll.|.r.-nl  In  n..r,,„,l  ...m.l.n.'      .»dUB 

Tl"«  K',l'r„,,,l  l."r,W..  ,M  06„„M.  Slllllw'.  ..nl...n..ut  .i.b  r.««nl  ...  th.-  dl..««:» 
lifl«f.-ii  II...  liKlivliliu.1  riirkli.j..  .-.ll"  1«  1."  f.illuw. : 

0.1.-rmlna",,^»..nHtr-.-krn,on  .l...n.l.T  ..»tl.rnt.  „n.l  l»«n  .1-  pi.;.."  '•"'■"'''"""'"■"a  '   h 

Z  Knit,.  nu.«  k  .on  l/iro'     «.-".-.»':  ""l"  "-l"-"  "■"""'"  f,^  "•«"  ""T'TmI,^'   D^ 
Mm.h.-n  Kl..n.!n  .in,l  .1.. .!«.«.»  .i...l...  ...lt.n..na  ..it,  U.  .,,  1  12  '  ,  von  ..in.n.kr  rnll    nt     I>. 

m.n  In  »Mn.-n  Al»..hnitt..n  .l..h  ....■i.l  nut  Th.llc  .l.-r  .in»ln..n  |ir»«.n  S«ven..-ll.n  (n.ut  lltt.  1  .u 

o".!h.r:.",t.,-,»l«.n.,.h.».n  ^.,..  on  ,n.nn,  K,«„,..n.„  ■^''-'^''ZZ^r^iZZ 
.urr.ll.'n.l  l.n«..  Sttock..  ohn..  Brn-"  N.-,™n.rll-n  .■r«-ho,nt.  l.«rn  ,i,.ll..ichl  .Icnn...  h  f l.^lrr.  a  • 
;„,'h  ,L  I-Hll-ftion  „nk™ntl„l,  ...nl-n,  In,n,..rhln  .1..,  .,o..n  In  .Ln,  .,,«l..n  ,!.■»  .  n  »  n.n 
,L..n  N,.rv..n.,.n..n  l«.tln.lli..h.n,  ,rn~..r,.n  o.l-r  kl.ln.n.n  Z.l«-h.nr.u,n,.n  ,lj.nn..-h  .1-  cln.eln.n 
llZont.  '|.r  !l..ll.-n-  nnd  Ko,n.r«h,.l.t  In  „n»ilWb...  IXrOh-un,  r,-,,.  V.Tl.,n.lun»,  .1.  h.  .. 
uhlloM>n  Ht.'n.'n. 

It  1...  I„,.l  .1-olt  .Kh  lhinn.T  ».^tln...,  ho  ««,l.l  .lm,l.ll«.  tnvo  m..t  .iti.  in.l.mc.'n  o( 
p,.„t..r  l„,..rv,.Kl«.., -v..,.  allowing  f.>rlh...lill..n.„.,.  I„  .hkkn.-.  ..  "■«""""•'' "'';'';  "™ 
Z  unlikely  Ihnt  iWn- 1-  li.  .ho  o»«.  l...n.  .I,.«rll.,l  n,.  „...,ml  .ll,.,l..,..l..n  In  '  -  '°'"'  '  2;' 
of  Purkhij.  .-llH  «.  ron,|»>n,l  wHh  S.ilUnK'.  «...«"«..    <  h.  .-.n.pnn-,.,  with  cn.n,  I'-P" ""<»'"• 

„.  1..,  n.pn.1.,0.,.  »  ».lin„  of  Ih-  h.  i"l.I.l»-  "'  ";••  "-"7  "•  »  '''".r"'" '™*  " 
„,.vn.th..nto  Itmvl..  h.  "hi'*  <ll~-"»  '1">"  I"  Pn-.u.n.bly  no  .1  min..l.on  in  th„  numlxr  of 
Piirkink. r.'llr..    T1.0  IntPrnpncT.  Ii.lw.vn  lolN  nn' »«n  to  1») Tory  Inrp'. 

I,'  K  "hn.V  ™.o  nf';,„,phy  ..t  Iho  „...Wlh,n;,  „..-.  with  in  n„  »'»«'-^: '•"l^-',^ 
D„,..hl«nV  l„l«ra.ory,  Ihoro  w».  oxl.-n.ivo  „t„,phy  of  Iho  cr-.U-llnn.  n.  «  "''"'^■;'''' "'."•" 
.liminullon  i,.  thick,.*.,  pntlicnkrly  of  Iho  moWnlnr  Inj.r.  n  plac.-.  th„  1  J,  ^'"^  "»"  ""^ 
,li«p,,..,nHl  ..nlln.ly,  l,.n.inK  open,  empty -pn.^,.  in  their  place.,  nnrt  Iho  "^'''^J"  "^l  "  ° 
B,.n.'n.l  w,.n,  ranrkodly  -hn.nken.  Then,  «en.«l  lo  be  but  UttI  lt.ral.on  .u  .he  granul»r  layer 
or  in  the  white  medullary  Bub.tau<». 

Cekural  cortex; 

0„n.»  cn„r,.li.  nn(.™r -The  |fr»y  matter  1.  2  mm.  thick  on  Ih,  .urface  2 Ji  to  8  mn. 
thick  on  the  wall,  of  the  .ulci.  The  pWform  layer  n...a.,.re.  0.319mm.  in  !'■  "!•»«■"•  Tl^e 
variou,  l,.y..r.  of  pyramidal  cell,  an,  pre«,„t  in  Ni.-1  pieparation..    I  can  make  out  no  definite 

n,^«,l  0.1156  mm.  in  depth.  I.  contain,  a  ..-ry  few  mattered  n,Klel,  the  ■""'""I'li^nlte, 
and  ro„..d  and  looki..g  Ilk.  ordinary  Rlia  n,.cl ...  A  few  po  ygon..l  and  »P  "'""f"'*^  ^"'^ 
are,  however,  al«.  pr..«.nt  in  Ihi.  layer.  The  layer  of  .n.«  1  W^^'dal  ceU.  a...  It"  '^^"'^ 
m.,di..m.m».d  pyramidal  cell,  toRether  meamtn,  0.M8  mm.  .n  depth.  The  layer  of  !"■«•  '«'™ 
Sro  133  mm.  deep,  that  of  the  «  all  .tellate  ell.,  0.292  mm.,  and  that  of  the  ™all  pyra- 
m.'d.  celK  with  aJ.,.dinK  axone.,  U.119mm.  d.*p.  The  giant  pjram,d«  »»'  "'1-'*'^ 
"movM  fLoneanother  and  their  cellbodie.  and  nuclei  look  normal  The  l-J"-- "'  P^""^ 
SZw^hcurvrf,  amending  axo„.-»mea,un»0.11«  mm.  in  depth  and  the h^erof.p,..dle-.haped 

cU.,  OJO.    The  total  thickuMS  of  the  gray  matter  her.  is  1.6  mm.  m  it.  thtnuMt  part. 

,w  o  K„.-,"A.»pb,otc™b.ll».l.c.t.-v~~.w«««».~l««.«l'x~«".'""''°''  I*-!"."")- 


i- «*»iii«_r.  B«»»i ( 

BteUMR  or  M.)|.BI„  AXATuMi  ' 

llio  hrilm  and  ,.u„|«  „f  |.,t|.  ,..^,  ,^ 

-v.;.).  n..  ,„..i„.i„„.  ,z  .h..  nor  :;;t;, ':,,i;7'"'''"' "■;■'-'»''>•■.'  ■>-. 

;;r  :"^  -^  ....„„„, ^,j^,.,  ...An^ir  :;,:,:•;.  ^-rr.:;; 

«.n«:::z:"'T::' "z!;:;::!!:::'"' -"  ■■- '>  -..-«■ .«.. 

"-;-" ' '-""Hor::!::;r::;:t;;:^:;-:::^;-"''".'"i..n » r.L 

xviii'u::: -i^rr:;^^::^^'-"'  '■ ^  -•  -  -'  c^ 

dentate  n«,.l,.„a  of  tl,o  «.n.|x.Ilum  and  ill  ^"'°  """"'  "'^-olv.'m.ntof  ,!,„ 

of  ....  inferior  olivary  nnC.uof'^^  ^jlr  '"7'"'""'"-.  ™'  I-Lahlv  „,« 

thore  may  be  a  -n«h.  diminution   ,„Iltro    7    'l  "'  "'°  ""'"'  "''™"""  - 

fibers  of  the  non-,.-rool.  '  "'"  ""'"'""'  ''»ra  «'ll8,  and  of  th,. 

b«  ^t:^z:  i^r  x';~::':  "■"- 1™  -' "- "-- "'-.  "- 

nonaged  in  the  dor™lf„nic.„,„V,h„nriro  arc!  7.r, "''"''  "  "''"""'■^  ■"""•  P- 
lo  th,.  dir«.l  cB,^b.ll,r  tract.  '"  "'  "■"  '"""''  '"°'''"'"»  ™rr™,„nclin« 

that  o.|^ff™„:r,/;™  I5;.'is:;x\r  w'f' "'°'""'  '''"'"''".-""y.  •>"< 

l..«.on,b„e  made  '.ul  .  marked  diminntio,   in  The  nlh^  "o  .■.r..nm«.rib,,l  o..r,...ilar 

■........■.^.j..„..^::£.';-*::r.':zt.rr~'" 


48   Descbiptiqs  of  Bbaim  and  Spisal  Ooid  in  Heeeditabi  Ataxia 

part  ot  the  fnsciculM  gracilis,  and  to  a  leaa  extent  the  posterior  |«>rt  of  this  fasciculm 
and  the  most  mi'dial  part  of  the  fasciculns  cmneatus.  ,    . ,     ,, 

In  general,  then,  the  lesions  in  the  three  cases  thus  far  studied  are  nearly  identi- 
cal as  regards  the  neurones  involved,  though  there  are  differences  in  the  extent  of  the 
process  quite  in  accord  with  the  differences  to  clinical  symptoms  as  the  cases  were 
more   or  less  advMiced.     Dr.  M.-ycr  interprets   the   degeneration   in   the  posterior 
funiculus  as  a  degeneration  ot  the  collaterals  which  connect  the  lower  leveU  with   he 
higher  (cerebral  and  cereliellar)  apparatus,  comparable  to  the  degeneration  of  the 
lateral  pyramidal  tracts  of  the  lower  segments  ot  the  cord  where  the  basilar  part  ot 
the  cerebral  lieduncle  and  the  pyramids  of  the  medulla  show  no  degeneration.     I  am 
incline.1  to  look  upon  the  degeneration  in  the  posterior  funiculus  rather  as  systemic; 
,■  c    as  involving  certain  only  ot  the  stem-flbers  and  collaterals  of  the  intramedullary 
continuation  of  the  posterior  roots,  namely,  those  corresponding  to  one  period  of 
medullation  in  the  embryo.     Recent  studies  make  it  appear  probable    1)  that    he 
medullalion  of  the  fibers  of  the  posterior  roots  corresponds  more  or  less  closely  to  the 
m«lullation  of  their  intraf  unicular  continuations,  and  (2)  that  the  fibers  of  the  posterior 
funiculi  which  terminate  in  the  nucleus  dorsalis  are  terminals  ot  the  mam  ascending 
limb  of  bifurcation  rather  than  collaterals.     In  the  near  future  the  writer  hopes,  in 
another  paper,  to  enter  into  a  rather  full  discussion  of  the  relation  of  the  lesions  found 
in   these  cases  to  the  clinical  symptoms  presented  by  the  patients  during  life,  a 
discussion  li-hich  necessarily  involves  some  consideration  ot   the  whole  question  of 
co-ordination.     The  discussion  ot  the  relations  ot  the  disease  to  Friedreich  s  ataxia 
and  similar  maladies,  and  ot  the  validity  ot  Marie's'  classification  of  hereditary  cere- 
bellar ataxia  is  also  deferred.     It  will  be  ot  especial  interest  to  contrast  the  Hand 
family  studied  clinically  by  Klippel  and  Durante  and  anatomically  by  Thomas  and 
Eoux  with  the  cases  described  above.      In  the  French  family  the  lesion  involved 
chiefly  the  ventrolateral  cerebellar  fasciculus  of  Gowers';  Meyer's  studies  and  my 
own  show  that,  in  the  American  family  described  by  Sanger  Brown,  the  dorsolotera 
cerebellar  tract  is  the  one  which  degenerates.     The  present  report  together  with  that 
ot  Dr.  Adolf  Meyer,  makes  it  very  clear  that  the  morbid  anatomy  of  the  affected 
members  of  the    family    described    by  Dr.  Sanger    Brown    presents  very  constant 
features;  we  now  know  with  certainty  the  neurone-systems  principally  involved  in 
the  imlividuals  who  are  affected,  though  we  are  as  yet  entirely  ignorant  as  to  why 
just  these  neurone-systems  should  be  picked  out. 

LEGENDS  FOR  FIQCRES  (PLATES  XXVIII-XXXIX) 

Fio  1— CaseXVm.  Cerebelhim.    Fiicies  superior. 

Pio  2-CilseXVIII.  Cerebellum  and  rhombencephalon.    Faciea  inferior. 

Fio  3  —Case  XVIII.  Cerebrum.    Hemisphneriura  dextrum,  polus  frontalis. 

Fig  4  -Case  XVIII.  Cerebrum.    Hemi»pho!rium  simBtnim,  iwlua  frontaUs. 

Fio  B -Case  XVIII.  Cerebrum.    Hemisphierium  sinistnim,  polus  occipitalis. 

Fio.  6.-Caae  XVIII.  Cerebrum.    HemisphKrium  deitrum,  polus  occipitalis. 

•  P  M..n.  "Sdt  l'Mrld».l..l.  rfrtbeU.™,"  Semal«.  mid..  P.tl.,  Vol.  Xlll  (l«m.  PP-  "1-'. 

3M 


Lewgllth  p.  Barker 


4!) 


Fio.  7.— CaseXVIII. 
Pio.  8.  -Ca»e  XVIII. 
Pro.  9.— Case  XVIII. 
Pio.  10.— Case  XVIII. 
Fio.  n.— Case  XVIII. 
Fio.  12.— Case  XX. 
Fio.  13.— Case  XX. 
Fio.  U.— Oiao  XX. 
Fio.  16.-C,i.se  XX. 
Pio.  16.— Case  XX. 
Fio.  17.-Ca<e  XX. 
Fio.  18.— Case  XX. 


Cerebrum. 
Cerebrum. 
Cerebrum. 

Cerebrum. 

Cerebrum. 


HemifiphsBrium  dextrum,  facicn  conveia. 

Hemispbeerium  sinUtrum,  facies  convexa. 

Hemisphierium  siDistrum,  facics  inferior. 
Hemisphierium  siuistrum,  fat-ies  suiierior. 
Hemispha'rium  dextrum,  facies  superior. 
Cerebrum.    Hemisphwrium  deilrum,  fiieies  convexa. 
Cerebrum.    Hemisphifrium  sinistnim,  facies  convexa. 
Cerebrum.    Hemiapha.riura  dextrum,  facies  medialis. 
Cerebrum.    Hemisph»riiim  sinislrum,  facies  medialis. 
Cerebrum.    Facies  superior. 
Basis  cerebri. 

PioW-C^yv  2°'*!'™''    H™'»Pterium  dexlrum,  polus  frontalis. 

Fo'Jo'    rl     vv  ^^"'"'-    H'-i'Pteriimsinistrum.polus  frontalis. 

r»'M"rrYT  ?*7'»"-Pl"'l'>»«"d  cerebellum.    Ventml  view. 

P^'w"?^v-  Cb'^'*"''™-    Fades  superior.    Left  half. 

PioS~?*'tv  ?"'!»'|!'"»-    Ficie.  superior.    Bight  half. 

FioS"?"tt  ?"'^'™-    F«cie.  inferior.    Bight  half. 

Fo.24.-Case  XX  Cerebellum.     Facies  inferior.     Left  half. 

suppi^ifnori'rtrSo'f'ss'reir '•■'''■"' "' " '"""  ■"»'■» "'  ■"^-*-"'  ^''-'- 

Fig.  2^!°'  ^-*""°"  "'™'«''  «"*'««°'  hemisphere  of  Ca«,  XX,  same  magnification  a,  in 
r!^' »  ~£IS  f^l""^"  ^P^""'  of  Case  XX;  same  magnification  „  in  Fig.  27 

nuiiof"rn''u^Srorc!u':s:5L"'°r:'r  "t^'t  ■""""■" "'  ^-^  ^^'  *°-°«  "i-- 

iu  many  otherlL°U..r  b^^  ?:„  ?    ".minufon  is  more  pronounced  in  this  section  than 
represented  '  "  ""^  ""^"^  P''^  "'"'"'  "■»  "'•1«  "»  «  lew  as  here 

of  ce,Mnfp;est."bVScr''°'"  "'  """  -'- °"™Hs  inferior,  showing  the  number 

scetionTsttin^et^hanlLtr^Fi'  S""T.'^'.u'' V*'"  °"™"'  '"'""'>'  »'  <=»'«'  ^X-    The 

oa.ffh5-rx^-:it;;-zXS^!'"'-"'^°-'-"^'^^ 

XX.  shifg-sjiTabiitfof  :^ri.Sir  ■""-'"'  '"'"*''  °' ""  ■™"  "'°'»*  -■  -^  ''- 

g.rt  pre;a«iL^'"""  "™*'' '"'""""'  '°'^*''  ■'■"'  P""  '»»"-»  Po"'i»  -"  Case  XX.    Wei- 
lion    ^m»'h,^!r"°''  "'""*''  •"■"  "'  '"""''  °'  '■""■hium  pontis.  Case  XX.     Weieert  Drepara- 

rugh^ii'^tTrosrrhoiiZr.r  "■'-'-  °' "-  '=•-''  •■°--  -  -=- 

iio.  88.-Section  through  the  upper  part  of  the  medulla  oblonpit;,,  Case  XX. 
896 


no     DeSCBTTION    of    BbAIS    and   SriNAL   CQ»U    IK   IlEBEUlTAKV    ATAJ»A 

Fin.  39.-S«:tloii  throUKh  the  mwJulk  olilongata  «l  lh„  fcvol  i.f  Hu-  tom.r  pilrt  of  the 

°"*Z''r'lt;:;r.hru«f  .be  meduH,  oUong^t.  u.  tUB  u„^.r  ,«.rt  „f  the  d»u,»a.io 

lemnist-orum  and  uueleua  olivaris  nccwaoriua.  Case  aX.  ,..,.„|  „f  il,. 

F.n  11      Sei'tion  throush  the  lower  part  ot  the  medulla  cbloDKaln  at  Ih,   level  <it  the 

■'  1         (-',.-..  TT      The  (leireueratiuu  ol  the  din-ct  cerebelhir  tracts  w  well 

irr' T.rd!:;t";u^':™  o'n  2'J:  Lrri^w,  „f  .n«i„iiat„.  «..r„  p,.i«%  a.. 

'■^'"1,f  "^^  "^Urt.^Jh  ;^«S  ealar^eoten.  of  the  -pinnl  cord  o,  Ca«  XVIH. 
Fiu  W     Section  through  the  .piual  cord  o!  Case  XVIII.    Pura  thorucalw. 
fIo  it-totiou    thro^h   the   .pinal   cord  of  Ca»  XVIII.     Iutume«>„,t,a  lutnbaha. 

'^"'Fro7r!-SectionlhK.UBhthe»pinalcordofCa»eXX.    Para  thoracalls. 

Fltk-Sectiou  through  the  spiual  ami  of  Case  XX.    Iutume«=ent.a  lumbalra.  Level 

of  L  ill 


Decevxiii.   Pi  hlk  atii)\s,  X 


I'MTi:   X.WIII 


m 


V 


t)ECE\XIAI.    PtHMIATIuNN,    X 


I'l.ATK    XXX 


Flo.  Il> 


DbcEKXIAI.    PUBtlOATIONK,    X 

§•  /  1 

^^^■tekT^Jpr  jA 

•^   V 

nY 

-.  \ 

,^,^ 

Plate  XXXI 


V 


Pra.  18 


Fio.  U 


DlCIKItlAL    PuSLIOATIOm,    X 


PtAT«  xxxn 


Fio.  n 


nri'iiKxiAi.  1*1  ni.ictTiiiNii,   X 


Pi.«T«  XXXIII 


Decennial  Publicationh,  X 


Plate  XXXIV 


Decennial  Publicationh,  X 


Plate  XXXV 


Fio.  82 


Fn.  8S 


Decennial  Publioationh,  X 


Plate  XXXVI 


I'm.  40 


Decennial  Piblicatiunh,  \ 


Plate  XXXVII 


\ 


DCCKXIAL   PUBLIOATIONK,    X 


PlATE   XXXVIII 


^  1 


DEmVNIAL   I'l  BLK  ATIIIN'K.    X 


Plate  XXXIX 


Fic.  i6 


"^y-l!^:^. 


